mechanisms operating in the common, sporadic cases. AnticiKeywords: leukemia; familial; anticipation pation occurs in Huntington disease, myotonic dystrophy, and other inherited neurodegenerative illness where it results from the expansion of unstable trinucleotide repeat sequences.
IntroductionSince this remains as the only molecularly defined instrument for anticipation, I weigh the possibility that an analogous situ-A family history of leukemia in a first degree relative increases ation holds for leukemia genes. I also review evidence that the risk for leukemia by approximately three-to five-fold.
1,2anticipation may be present in other types of familial cancer, The magnitude of this risk elevation is equivalent to or even including those in which the gene has been characterized and greater than that exhibited for malignancies well known to does not contain trinucleotide repeat tracts, but is involved have a substantial proportion of cases resulting from autosoin maintaining genome integrity. Here I propose a novel and mal dominant inheritance of a mutant tumor suppressor gene, alternative hypothesis for anticipation in familial cancer based such as breast cancer 3 and colorectal carcinoma. 4 On the on the inheritance of a cascade of de novo mutations in secother hand, familial leukemia is exceptionally rare, and only a ondary tumor suppressor genes resulting from a primary defect few pedigrees obviously transmitting leukemia have ever been in a gene responsible for DNA fidelity. recognized. This paradox and other observations suggest that the fraction of leukemia attributable to heritable factors could be markedly under appreciated. First, acute lymphocytic leuLeukemia as part of a syndrome kemia (ALL) is predominately a disease of childhood. 5 In other childhood malignancy, such as retinoblastoma and Wilm's Several syndromic illnesses have leukemia as a component tumor, a large proportion of cases are the result of germline feature (Table 1) Since M7 AML is relatively rare in the general population, the