Pre-B-cell leukemia with a t(8; 14) and a t(14; 18) translocation is preceded by follicular lymphoma

We have performed gene rearrangement studies on the leukemic blasts of a patient with acute pre-B-cell leukemia. The patient had a 5 year history of follicular lymphoma, which developed into acute pre-B-cell leukemia. The leukemic blasts revealed a karyotype with two translocations, t(8; 14) and t(14; 18), characteristic for Burkitt's lymphoma and follicular lymphoma. The cells are TdT positive, do not possess surface immunoglobulin, and they show immunoglobulin gene rearrangement. The mu heavy chain and kappa light chain constant (C mu and C kappa) loci are deleted, while the gamma and lambda light chain constant (C gamma and C lambda) region genes are rearranged. Both alleles of the heavy chain joining segment (JH) are rearranged on chromosome 14q+, one of them with the bcl-2 oncogene from chromosome 18. The breakpoint of the t(14; 18) translocation occurs in the major breakpoint cluster region in the 3' untranslated region of bcl-2. On chromosome 8 a c-myc rearrangement was mapped immediately 5' to the c-myc first exon in a region involved in sporadic Burkitt lymphoma. The data are consistent with our previous hypothesis on the evolution of B-cell malignancies: a rare pre-B cell develops a t(14; 18) translocation during immunoglobulin VDJ joining that results in an expansion of a follicular lymphoma clone carrying an activated bcl-2 gene. Within the clone of pre-B cells a second translocation, t(8; 14), occurs during heavy chain isotype switching that results in the deregulation of the c-myc involved in the translocation.