Twin study confirms childhood leukemia starts in the womb and could help guide screening when only one twin is affected icrnews
]. The fusion gene was however absent from the neonatal blood spots of both twins, but they did share an identicalfusion, may have been the pre-natal initiating event.
These observations raise some practical issues that follow when a twin is diagnosed with leukaemia. Parents have the additional burden of concern that the other twin will be at risk and need informed advice. We are aware of parents being told the risk to the second twin was one in a million, and in another case , inevitable or 100%; both very wide of the mark. We now advise first ascertaining that the twins are identical, with genetic screening if necessary.
For twin patients where one is diagnosed with the more common subtype of B cell precursor ALL, the risk level conveyed to parents should be in the range of 15–25%. If the co-twin is clinically well there is a case for clinicians and parents to consider for examination of blood for clonal markers of leukaemia cells that were present in the twin diagnosed with ALL. Markers chosen should be those likely to be early or initiating mutations .
When the co-twin of a patient with leukaemia is clinically well, but has detectable, low level pre-leukaemic cells in the blood we have, in consultation with clinicians and parents, offered screening of the blood of the healthy co-twin every three months for one year and less frequently thereafter. The purpose of the screen is to determine if the level of putative pre-leukaemic cells remains very low or is increasing.
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