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Concordant childhood acute lymphoblastic leukemia in monozygotic twins
Y M Chin1, A Wan Ariffin, H P Lin
1Division of Haematology, Institute for Medical Research, Kuala Lumpur.
Insights
Identical twins developed acute lymphoblastic leukemia (ALL) simultaneously. This suggests the cancer originated in one twin before birth and spread to the other via shared placental circulation.
Area of Science:
- Pediatric Oncology
- Hematology
- Genetics
Background:
- Childhood acute lymphoblastic leukemia (ALL) is a common pediatric cancer.
- Monozygotic twins share nearly identical genetic material.
- Understanding concordant twin ALL can provide insights into leukemogenesis.
Observation:
- Two 4-year-old identical Chinese female twins presented with concordant acute lymphoblastic leukemia (ALL) within a two-week period.
- Bone marrow morphology and cytochemistry confirmed ALL, L1 subtype in both twins.
- Immunophenotyping revealed identical antigen expression profiles on leukemic cells from both individuals.
Findings:
- The twins exhibited identical blood groups, HLA genotypes, sex, and physical appearance, confirming monozygosity.
- Leukemic cells in both twins showed identical morphology and similar antigen expression percentages, indicating a single clonal origin.
- The findings support the hypothesis that leukemogenic events occurred in utero.
Implications:
- This case suggests that leukemia cells can spread between monozygotic twins through shared placental vasculature.
- The study provides evidence for the in utero origin and transmission of leukemia in identical twins.
- Further research into placental anastomoses and early leukemogenesis in twins is warranted.
Abstract:
Two 4-year-old monozygotic Chinese, female twins developed concordant childhood acute lymphoblastic leukemia (ALL) within an interval of about 2 weeks. Based on morphology and cytochemistry findings of the bone marrow blast cells, a diagnosis of ALL, L1 was made. Immunophenotyping showed the blast cells of both twins expressed similar antigens, i.e. HLA-DR, CD10, CD13, CD19, CD22 and CD34. Identical blood group, same HLA (human leucocyte antigen) genotype, sex and similar appearance suggest that the twins are monozygotic. Since the bone marrow leukemic cells of both twins were identical in morphology and expressed the same antigens with almost similar percentages of positivity, it is likely that the blast cells were derived from the same single clone. Based on the single clone hypothesis, the leukemogenic event must have arisen in utero in one twin and the cells from the abnormal clone then spread to the other twin via shared placental anastomoses.
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