IntroductionMolecular aberrations involving the mixed lineage leukemia (MLL) gene on 11q23 are found in 5% to 10% of acute leukemia cases. 1 In B-cell precursor (BCP) acute lymphoblastic leukemia (ALL), these aberrations are largely restricted to the immature CD10 Ϫ immunophenotypes (pro-B and CD10 Ϫ pre-B). The translocation t(4;11)(q22;q23) with MLL-AF4 (MLL-AFF1) fusion is known to be the most prevalent MLL fusion gene in ALL, but precise and reliable data regarding the prevalence of the different MLL fusion partner genes, that is, the MLL "recombinome" in adult ALL are lacking. Knowledge of the MLL recombinome is warranted, since MLL fusions are of interest in detecting minimal residual disease in affected patients 2,3 and also because controversy exists over whether adult ALL patients with pro-B ALL immunophenotype with or without MLL aberration might have a different prognosis. [4][5][6] We report our experience within the framework of the German Multicenter Therapy Trials for Adult ALL (GMALL) between January 2001 and October 2007 at the central diagnostic laboratory of the GMALL study group.We investigated 184 patients with a CD10 Ϫ BCP immunophenotype by reverse transcription polymerase chain reactions (RT-PCRs) for different MLL fusion genes. Since the chromosomal breakpoints in the MLL gene cluster in a relatively restricted region between exons 8 and 13 (numbering according to Nilsson et al 7 ), encompassing approximately 8.2 kb, we additionally investigated all samples by a recently published long-distance inverse polymerase chain reaction (LDI-PCR) method that also allowed the identification of unknown MLL translocation partners at the DNA level.
Methods
Patient materialBone marrow (n ϭ 136) and peripheral blood (n ϭ 45) samples (n ϭ 3 samples unspecified) were obtained for diagnostic purposes within the framework of the GMALL therapy studies 6/99 and 7/03 between January 2001 and October 2007. A list of GMALL study participants appears in the Supplemental Materials and Methods (available on the Blood website; see the Supplemental Materials link at the top of the online article). All samples were taken at the time of primary diagnosis and had a high blast count, as revealed by flow cytometry. The genetic investigations were done retrospectively and prospectively on archived residual material. Preparation of samples, immunophenotyping, and all RT-PCR investigations were performed at the central diagnostic laboratory of the GMALL study group in Berlin. The samples were obtained within clinical studies that were approved by the institutional ethics committees of all participating institutions. The study design and our investigations were conducted in accordance with the Declaration of Helsinki.
Nucleic acid isolation and reverse transcriptionTotal RNA was isolated using the TRIZOL method (Invitrogen, Carlsbad, CA) or the RNEasy kit (QIAGEN, Hilden, Germany). Genomic DNA was For personal use only. on May 12, 2018. by guest www.bloodjournal.org From isolated using the PureGene Kit (Gentra Systems, Mi...