Finding Suggests a Common Childhood Leukemia May Form in the Womb

By Jennifer O'Brien

Researchers led by a scientist who joined the UC San Francisco faculty last
week are reporting that a genetic mutation implicated in a common form of
childhood leukemia appears to occur in the womb.

Their study, reported in the Oct. 30 issue of Lancet, indicates that two genes,
known as TEL and AML1, aberrantly fuse during the development of the blood
cells in the fetus. The fused genes then produce a protein that is potentially

Based on previous research, the team says the fused state of the two genes is
not inherited; instead, it occurs during pregnancy, probably as a result of a
developmental accident, as opposed to exposure to an environmental mutagen.

Importantly, the fusion of the TEL and AML1 genes is not sufficient to cause
development of the disease, known as “common acute lymphoblastic leukemia,” the
researchers said. All people have two copies of every gene, and earlier work by
the researchers on identical twins with leukemia indicates that a second
genetic alteration - involving the second copy of the TEL gene, one of the two
so-called “alleles”—occurs post-natally to actually nudge blood cells into a
leukemic state.

“It may be that the normal TEL allele successfully suppresses the function of
the aberrant TEL-AML1 protein resulting from the fusion, so full-blown leukemia
doesn’t occur,” said the lead author of the study, Joseph Wiemels, PhD, now a
UCSF assistant research molecular epidemiologist. “One theory is that the
second, normal TEL allele is lost, and that at this point the fused TEL-AML1
protein becomes oncogenic.”

The researchers don’t know what leads to the initial genetic abnormality in the
womb, but their discovery, said Wiemels, will provide researchers with a time
frame for analyzing the development of the mutation.  Studies indicate that the
second genetic alteration may result from an abnormal reaction to common
childhood infections.

Wiemels conducted the research in the laboratory of Mel Greaves, PhD, professor
of cell biology, in the Leukaemia Research Fund for Cell and Molecular Biology
at the Institute of Cancer Research, in London. The work was conducted in
collaboration with researchers at the University of Milan, Italy and the Royal
Manchester Children’s Hospital, UK.

Common acute lymphoblastic leukemia usually develops in children between the
ages of two and five years, and accounts for approximately 80 percent of the
cases of childhood leukemia.  It is diagnosed in approximately 2,500 children
in the United States each year, and is curable with chemotherapy in about
three-quarters of patients. 

The researchers conducted their study by using a highly sensitive probe to
scrutinize minute numbers of leukemia cells in blood samples previously
collected from newborns who during childhood were diagnosed with leukemia. 
These samples, known as Guthrie cards, or blood spots, are routinely drawn from
newborns, with a prick to the heel, in order to diagnose such genetic disorders
as thalassemia and Phenylketonuria, or PKU.

The scientists examined blood samples from one set of identical twins, and from
nine other children, and detected the mutation in the twins and in six of the
nine singletons.  In the three other cases, the mutation was not revealed,
perhaps, said Wiemels, because the pre-leukemic cells were too rare to be
detected in the miniscule blood spot. The identical twins most strongly
demonstrated that the mutation occurred prenatally because the samples from
both newborns, who have the same genes, revealed the mutation.

“Our previous studies of identical twins indicate a prenatal origin of
childhood leukemia that in some cases was diagnosed in children up to 14 years
of age.  That evidence, combined with the present study, suggests that
childhood leukemia may regularly be initiated before birth,” said Wiemels.

Co-authors of the study were Giovanni Cazzaniga, PhD, Maria Daniotti, BSc,
Giuseppe Masera, MD, and Andrea Biondi, MD, of Centro Ricerca Tettamanti,
Clinica Pediatrica, Universita di Milano, Ospedale San Gerardo, Milan, Italy;
Osborn B. Eden, FRCP, of the Academic Unit of Paediatric Oncology, Christie
Hospital NHS Trust, Manchester, UK; G. M. Addison, FRCPath, of the Department
of Clinical Biochemistry, Royal Manchester Children’s Hospital, Manchester; and
V. Saha, FRCPCH, of the Department of Paediatric Haematology and Oncology,
Royal London Hospital, London.

The study was supported by the Leukaemia Research Fund, the Cancer Research
Campaign, and the Fondazione Tettamanti, Associazione Italiana per la Ricerca
sul Cancro and MURST.