Cancer in Inherited Bone Marrow Failure Syndromes

Background:

A prospective cohort of Inherited Bone Marrow Failure Syndrome (IBMFS) will provide new
information regarding cancer rates and types in these disorders.

Mutations in IBMFS genes are relevant to carcinogenesis in sporadic cancers.

Patients with IBMFS who develop cancer differ in their genetic and/or environmental features
from patients with IBMFS who do not develop cancer.

These cancer-prone families are well suited for cancer screening and prevention trials
targeting those at increased genetic risk of cancer.

Carriers of IBMFS gene mutations are at increased risk of cancer.

The prototype disorder is Fanconi's Anemia (FA); other IBMFS will also be studied.

Objectives:

To determine the types and incidence of specific cancers in patients with an IBMFS.

To investigate the relevance of IBMFS gene mutations in the carcinogenesis pathway of the
sporadic counterparts of IBMFS-associated cancers.

To identify risk factors for IBMFS-related cancers in addition to the primary germline
mutations.

To determine the risk of cancer in IBMFS carriers.

Eligibility:

North American families (or other eligible families) with a proband with an IBMFS.

IBMFS suspected by phenotype, confirmed by mutation in an IBMFS gene, or by clinical
diagnostic test.

Fanconi's anemia: birth defects, marrow failure, early onset malignancy; positive chromosome
breakage result.

Diamond Blackfan anemia: pure red cell aplasia; elevated red cell adenosine deaminase.

Dyskeratosis congenita: dysplastic nails, lacey pigmentation, leukoplakia; marrow failure.

Shwachman Diamond Syndrome: malabsorption; neutropenia.

Amegakaryocytic thrombocytopenia: early onset thrombocytopenia.

Thrombocytopenia absent radii: absent radii; early onset thrombocytopenia.

Severe Congenital Neutropenia: neutropenia, pyogenic infections, bone marrow maturation
arrest.

Pearson's Syndrome: malabsorption, neutropenia, marrow failure, metabolic acidosis; ringed
sideroblasts.

Other bone marrow failure syndromes: e.g. Revesz Syndrome, WT, IVIC, radio-ulnar synostosis,
ataxia-pancytopenia.

First degree relatives of IBMFS-affected subjects as defined here, i.e. siblings (half or
full), biologic parents, and children.

Grandparents of IBMFS-affected subjects.

Patients in the general population with sporadic tumors of the types seen in the IBMFS (head
and neck, gastrointestinal, and anogenital cancer), with none of the usual risk factors (e.g.
smoking, drinking, HPV).

Design:

Natural history study, with questionnaires, clinical evaluations, clinical and research
laboratory test, review of medical records, cancer surveillance.

Primary endpoints are all cancers, solid tumors, and cancers specific to each type of IBMFS.

Secondary endpoints are markers of pre-malignant conditions, such as leukoplakia, serum or
tissue evidence of carcinogenic viruses, and bone marrow morphologic myelodyplastic syndrome
or cytogenetic clones.

- INCLUSION CRITERIA - PATIENTS:

- Fanconi s anemia.

- Diamond Blackfan anemia.

- Dyskeratosis congenita.

- Shwachman Diamond Syndrome.

- Amegakaryocytic thrombocytopenia.

- Thrombocytopenia absent radii.

- Severe congenital neutropenia.

- Pearson s Syndrome.

- Other bone marrow failure syndromes.

- First degree relatives of IBMFS-affected subjects as defined here, i.e. siblings (half
or full), biologic parents, and children.

- Grandparents of IBMFS-affected subjects, specifically for Hypothesis 4.

- Patients in the general population with sporadic tumors of the types seen in the IBMFS
(head and neck, gastrointestinal, and anogenital cancer), with none of the usual risk
factors for those tumors (e.g. smoking, drinking, HPV).

- Adult patients and family members who are unable to provide consent.

EXCLUSION CRITERIA - PARENT PROTOCOL:

- Evidence that the hematologic disorder is acquired rather than genetic. Such evidence
includes temporal relation of the aplastic anemia to known marrow suppressant drugs,
chemicals, toxins, or viruses (in the absence of evidence indicative of an inherited
marrow failure disorder).

- Known causes of cytopenias such as autoantibodies to red cells, platelets, or
neutrophils, viruses (especially hepatitis), micronutrient deficiencies, transient
erythroblastopenia of childhood, and cyclic neutropenia.

- Assignment of the patient s physical findings to other syndromes or causes that are
not part of the IBMFS disease spectrum.

- Unwillingness to permit access to medical records and pathology specimens.

There are no other exclusion parameters not related to the primary disease.