Abstract

X-linked sideroblastic anemia (XLSA) in female carriers of 5-aminolevulinic acid synthase 2 mutations is not uncommon. We describe unique features and genotype/phenotype correlations in females with XLSA and evaluate the contributions of X-chromosome skewing and clonal hematopoiesis, emphasizing the importance of distinguishing it from myelodysplastic syndromes with ring sideroblasts.

1.
Ducamp
S
,
Fleming
MD
.
The molecular genetics of sideroblastic anemia
.
Blood
.
2019
;
133
(
1
):
59
-
69
.
2.
Fujiwara
T
,
Harigae
H
.
Molecular pathophysiology and genetic mutations in congenital sideroblastic anemia
.
Free Radic Biol Med
.
2019
;
133
:
179
-
185
.
3.
Bergmann
AK
,
Campagna
DR
,
McLoughlin
EM
, et al
.
Systematic molecular genetic analysis of congenital sideroblastic anemia: evidence for genetic heterogeneity and identification of novel mutations
.
Pediatr Blood Cancer
.
2010
;
54
(
2
):
273
-
278
.
4.
Fouquet
C
,
Le Rouzic
MA
,
Leblanc
T
, et al
.
Genotype/phenotype correlations of childhood-onset congenital sideroblastic anaemia in a European cohort
.
Br J Haematol
.
2019
;
187
(
4
):
530
-
542
.
5.
Bottomley
SS
.
Secondary iron overload disorders
.
Semin Hematol
.
1998
;
35
(
1
):
77
-
86
.
6.
Bottomley
SS
.
Sideroblastic anemia
.
Hosp Pract (Off Ed)
.
1991
;
26
(
suppl 3
):
37
-
40
.
7.
Bottomley
SS
,
May
BK
,
Cox
TC
,
Cotter
PD
,
Bishop
DF
.
Molecular defects of erythroid 5-aminolevulinate synthase in X-linked sideroblastic anemia
.
J Bioenerg Biomembr
.
1995
;
27
(
2
):
161
-
168
.
8.
Aivado
M
,
Gattermann
N
,
Bottomley
S
.
X chromosome inactivation ratios in female carriers of X-linked sideroblastic anemia
.
Blood
.
2001
;
97
(
12
):
4000
-
4002
.
9.
Aivado
M
,
Gattermann
N
,
Rong
A
, et al
.
X-linked sideroblastic anemia associated with a novel ALAS2 mutation and unfortunate skewed X-chromosome inactivation patterns
.
Blood Cells Mol Dis
.
2006
;
37
(
1
):
40
-
45
.
10.
Campagna
DR
,
de Bie
CI
,
Schmitz-Abe
K
, et al
.
X-linked sideroblastic anemia due to ALAS2 intron 1 enhancer element GATA-binding site mutations
.
Am J Hematol
.
2014
;
89
(
3
):
315
-
319
.
11.
Oakley
JH
,
Campagna
DR
,
Sun
L
, et al
.
A synonymous coding variant that alters ALAS2 splicing and causes X-linked sideroblastic anemia
.
Pediatr Blood Cancer
.
2022
;
69
(
1
):
e29309
.
12.
Ginzburg
YZ
.
Hepcidin and its multiple partners: complex regulation of iron metabolism in health and disease
.
Vitam Horm
.
2023
;
123
:
249
-
284
.
13.
DeZern
AE
,
Malcovati
L
,
Ebert
BL
.
CHIP, CCUS, and other acronyms: definition, implications, and impact on practice
.
Am Soc Clin Oncol Educ Book
.
2019
;
39
:
400
-
410
.
14.
Sperling
AS
,
Gibson
CJ
,
Ebert
BL
.
The genetics of myelodysplastic syndrome: from clonal haematopoiesis to secondary leukaemia
.
Nat Rev Cancer
.
2017
;
17
(
1
):
5
-
19
.
15.
Kluk
MJ
,
Lindsley
RC
,
Aster
JC
, et al
.
Validation and implementation of a custom next-generation sequencing clinical assay for hematologic malignancies
.
J Mol Diagn
.
2016
;
18
(
4
):
507
-
515
.
16.
Alter
BP
,
Rosenberg
PS
,
Day
T
, et al
.
Genetic regulation of fetal haemoglobin in inherited bone marrow failure syndromes
.
Br J Haematol
.
2013
;
162
(
4
):
542
-
546
.
17.
Link
MP
,
Alter
BP
.
Fetal-like erythropoiesis during recovery from transient erythroblastopenia of childhood (TEC)
.
Pediatr Res
.
1981
;
15
(
7
):
1036
-
1039
.
18.
Astner
I
,
Schulze
JO
,
van den Heuvel
J
,
Jahn
D
,
Schubert
WD
,
Heinz
DW
.
Crystal structure of 5-aminolevulinate synthase, the first enzyme of heme biosynthesis, and its link to XLSA in humans
.
EMBO J
.
2005
;
24
(
18
):
3166
-
3177
.
19.
Taylor
JL
,
Brown
BL
.
Structural basis for dysregulation of aminolevulinic acid synthase in human disease
.
J Biol Chem
.
2022
;
298
(
3
):
101643
.
20.
Malcovati
L
,
Karimi
M
,
Papaemmanuil
E
, et al
.
SF3B1 mutation identifies a distinct subset of myelodysplastic syndrome with ring sideroblasts
.
Blood
.
2015
;
126
(
2
):
233
-
241
.
21.
Malcovati
L
,
Stevenson
K
,
Papaemmanuil
E
, et al
.
SF3B1-mutant MDS as a distinct disease subtype: a proposal from the International Working Group for the Prognosis of MDS
.
Blood
.
2020
;
136
(
2
):
157
-
170
.
22.
Todisco
G
,
Creignou
M
,
Bernard
E
, et al
.
Integrated genomic and transcriptomic analysis improves disease classification and risk stratification of MDS with ring sideroblasts
.
Clin Cancer Res
.
2023
;
29
(
20
):
4256
-
4267
.
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