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One of the long known recurrent rearrangements in BCP\u2010ALL is t(1;19)(q23;p13.3)\/<jats:italic>TCF3<\/jats:italic>::<jats:italic>PBX1<\/jats:italic>. However, other <jats:italic>TCF3<\/jats:italic> gene rearrangements were also described that are associated with significant difference in ALL prognosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The current study aimed to analyze the spectrum of <jats:italic>TCF3<\/jats:italic> gene rearrangements in children in Russian Federation. A cohort of 203 patients with BCP\u2010ALL was selected based on FISH screening and was studied by karyotyping, FISH, RT\u2010PCR and high throughput sequencing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>T(1;19)(q23;p13.3)\/<jats:italic>TCF3<\/jats:italic>::<jats:italic>PBX1<\/jats:italic> is the most common aberration in <jats:italic>TCF3<\/jats:italic>\u2010positive pediatric BCP\u2010ALL (87.7%), with its unbalanced form prevailing. It resulted from <jats:italic>TCF3<\/jats:italic>::<jats:italic>PBX1<\/jats:italic> exon 16\u2010exon 3 fusion junction (86.2%) or unconventional exon 16\u2010exon 4 junction (1.5%). Rarer events included t(12;19)(p13;p13.3)\/<jats:italic>TCF3<\/jats:italic>::<jats:italic>ZNF384<\/jats:italic> (6.4%) and t(17;19)(q21\u2010q22;p13.3)\/<jats:italic>TCF3<\/jats:italic>::<jats:italic>HLF<\/jats:italic> (1.5%). The latter translocations demonstrated high molecular heterogeneity and complex structure\u2014four distinct transcripts were shown for <jats:italic>TCF3<\/jats:italic>::<jats:italic>ZNF384<\/jats:italic> and each patient with <jats:italic>TCF3<\/jats:italic>::<jats:italic>HLF<\/jats:italic> had a unique transcript. These features hamper <jats:italic>TCF3<\/jats:italic> rearrangement primary detection by molecular methods and brings FISH screening to the fore. A case of novel <jats:italic>TCF3<\/jats:italic>::<jats:italic>TLX1<\/jats:italic> fusion in a patient with t(10;19)(q24;p13) was also discovered. Survival analysis within the national pediatric ALL treatment protocol demonstrated the severe prognosis of <jats:italic>TCF3<\/jats:italic>::<jats:italic>HLF<\/jats:italic> compared to both <jats:italic>TCF3<\/jats:italic>::<jats:italic>PBX1<\/jats:italic> and <jats:italic>TCF3<\/jats:italic>::<jats:italic>ZNF384<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>So, high molecular heterogeneity of <jats:italic>TCF3<\/jats:italic> gene rearrangement in pediatric BCP\u2010ALL was demonstrated and a novel fusion gene <jats:italic>TCF3<\/jats:italic>::<jats:italic>TLX1<\/jats:italic> was described.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijlh.14072","type":"journal-article","created":{"date-parts":[[2023,4,14]],"date-time":"2023-04-14T15:35:21Z","timestamp":1681486521000},"page":"533-540","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["<i>TCF3<\/i> gene rearrangements in 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