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DOI: 10.1055/s-0031-1291377
Congenital Amegakaryocytic Thrombocytopenia: Clinical Presentation, Diagnosis, and Treatment
Publication History
Publication Date:
18 November 2011 (online)

ABSTRACT
Congenital amegakaryocytic thrombocytopenia (CAMT, MIM #604498) is a rare inherited bone marrow failure syndrome presenting as isolated hypomegakaryocytic thrombocytopenia at birth without other characteristic physical anomalies. Most of the patients develop a severe aplastic anemia and trilineage cytopenia during the first years of life and hematopoietic stem cell transplantation is the only curative treatment. In most of the cases the disease is caused by homozygous or compound heterozygous mutations in the gene MPL encoding the receptor for the hematopoietic growth factor thrombopoietin. The present review summarizes clinical and laboratory data for 96 patients with CAMT, reported since 1990.
KEYWORDS
Bone marrow failure - thrombopoietin - MPL gene - hematopoietic stem cell transplantation - thrombocytopenia
REFERENCES
- 1
Online Mendelian Inheritance in Man .
Amegakaryocytic thrombocytopenia, congenital; CAMT.
http://www.ncbi.nlm.nih.gov/omim/604498
(Feb 25, 2011)
Reference Ris Wihthout Link
- 2
Ihara K, Ishii E, Eguchi M et al..
Identification of mutations in the c-mpl gene in congenital amegakaryocytic thrombocytopenia.
Proc Natl Acad Sci U S A.
1999;
96
(6)
3132-3136
Reference Ris Wihthout Link
- 3
Ballmaier M, Germeshausen M, Schulze H et al..
c-mpl mutations are the cause of congenital amegakaryocytic thrombocytopenia.
Blood.
2001;
97
(1)
139-146
Reference Ris Wihthout Link
- 4
Kaushansky K.
Thrombopoietin: the primary regulator of platelet production.
Blood.
1995;
86
(2)
419-431
Reference Ris Wihthout Link
- 5
Ballmaier M, Germeshausen M.
Advances in the understanding of congenital amegakaryocytic thrombocytopenia.
Br J Haematol.
2009;
146
(1)
3-16
Reference Ris Wihthout Link
- 6
Auerbach A D.
A test for Fanconi's anemia.
Blood.
1988;
72
(1)
366-367
Reference Ris Wihthout Link
- 7
Freedman M H.
Congenital Marrow Failure Syndromes and Malignant Hematopoietic Transformation.
Oncologist.
1996;
1
(6)
354-360
Reference Ris Wihthout Link
- 8
Guinan E C, Lee Y S, Lopez K D et al..
Effects of interleukin-3 and granulocyte-macrophage colony-stimulating factor on thrombopoiesis
in congenital amegakaryocytic thrombocytopenia.
Blood.
1993;
81
(7)
1691-1698
Reference Ris Wihthout Link
- 9
Muraoka K, Ishii E, Tsuji K et al..
Defective response to thrombopoietin and impaired expression of c-mpl mRNA of bone
marrow cells in congenital amegakaryocytic thrombocytopenia.
Br J Haematol.
1997;
96
(2)
287-292
Reference Ris Wihthout Link
- 10
Henter J I, Winiarski J, Ljungman P, Ringdén O, Ost A.
Bone marrow transplantation in two children with congenital amegakaryocytic thrombocytopenia.
Bone Marrow Transplant.
1995;
15
(5)
799-801
Reference Ris Wihthout Link
- 11
Muraoka K, Ishii E, Ihara K et al..
Successful bone marrow transplantation in a patient with c-mpl-mutated congenital
amegakaryocytic thrombocytopenia from a carrier donor.
Pediatr Transplant.
2005;
9
(1)
101-103
Reference Ris Wihthout Link
- 12
MacMillan M L, Davies S M, Wagner J E, Ramsay N K.
Engraftment of unrelated donor stem cells in children with familial amegakaryocytic
thrombocytopenia.
Bone Marrow Transplant.
1998;
21
(7)
735-737
Reference Ris Wihthout Link
- 13
Guinan E C, Boussiotis V A, Neuberg D et al..
Transplantation of anergic histoincompatible bone marrow allografts.
N Engl J Med.
1999;
340
(22)
1704-1714
Reference Ris Wihthout Link
- 14
Lackner A, Basu O, Bierings M et al..
Haematopoietic stem cell transplantation for amegakaryocytic thrombocytopenia.
Br J Haematol.
2000;
109
(4)
773-775
Reference Ris Wihthout Link
- 15
van den Oudenrijn S, Bruin M, Folman C C et al..
Mutations in the thrombopoietin receptor, Mpl, in children with congenital amegakaryocytic
thrombocytopenia.
Br J Haematol.
2000;
110
(2)
441-448
Reference Ris Wihthout Link
- 16
van den Oudenrijn S, de Haas M, von dem Borne A E.
Screening for c-mpl mutations in patients with congenital amegakaryocytic thrombocytopenia
identifies a polymorphism.
Blood.
2001;
97
(11)
3675-3676
Reference Ris Wihthout Link
- 17
van den Oudenrijn S, Bruin M, Folman C C, Bussel J, de Haas M, von dem Borne A E.
Three parameters, plasma thrombopoietin levels, plasma glycocalicin levels and megakaryocyte
culture, distinguish between different causes of congenital thrombocytopenia.
Br J Haematol.
2002;
117
(2)
390-398
Reference Ris Wihthout Link
- 18
King S, Germeshausen M, Strauss G, Welte K, Ballmaier M.
Congenital amegakaryocytic thrombocytopenia: a retrospective clinical analysis of
20 patients.
Br J Haematol.
2005;
131
(5)
636-644
Reference Ris Wihthout Link
- 19
Germeshausen M, Ballmaier M, Welte K.
MPL mutations in 23 patients suffering from congenital amegakaryocytic thrombocytopenia:
the type of mutation predicts the course of the disease.
Hum Mutat.
2006;
27
(3)
296
Reference Ris Wihthout Link
- 20
Yeşilipek H V, Hazar V, Küpesiz A, Yegin O.
Peripheral stem cell transplantation in a child with amegakaryocytic thrombocytopenia.
Bone Marrow Transplant.
2000;
26
(5)
571-572
Reference Ris Wihthout Link
- 21
Kudo K, Kato K, Matsuyama T, Kojima S.
Successful engraftment of unrelated donor stem cells in two children with congenital
amegakaryocytic thrombocytopenia.
J Pediatr Hematol Oncol.
2002;
24
(1)
79-80
Reference Ris Wihthout Link
- 22
Al-Ahmari A, Ayas M, Al-Jefri A, Al-Mahr M, Rifai S, El-Solh H.
Allogeneic stem cell transplantation for patients with congenital amegakaryocytic
thrombocytopenia (CAT).
Bone Marrow Transplant.
2004;
33
(8)
829-831
Reference Ris Wihthout Link
- 23
Steele M, Hitzler J, Doyle J J et al..
Reduced intensity hematopoietic stem-cell transplantation across human leukocyte antigen
barriers in a patient with congenital amegakaryocytic thrombocytopenia and monosomy
7.
Pediatr Blood Cancer.
2005;
45
(2)
212-216
Reference Ris Wihthout Link
- 24
Gandhi M J, Pendergrass T W, Cummings C C, Ihara K, Blau C A, Drachman J G.
Congenital amegakaryocytic thrombocytopenia in three siblings: molecular analysis
of atypical clinical presentation.
Exp Hematol.
2005;
33
(10)
1215-1221
Reference Ris Wihthout Link
- 25
Passos-Coelho J L, Sebastião M, Gameiro P et al..
Congenital amegakaryocytic thrombocytopenia—report of a new c-mpl gene missense mutation.
Am J Hematol.
2007;
82
(3)
240-241
Reference Ris Wihthout Link
- 26
Pemberton L C, Levett D, Skinner R, Hall A G, Hanley J P.
Novel mutations in a child with congenital amegakaryocytic thrombocytopenia.
Br J Haematol.
2006;
135
(5)
742-743
Reference Ris Wihthout Link
- 27
Savoia A, Dufour C, Locatelli F et al..
Congenital amegakaryocytic thrombocytopenia: clinical and biological consequences
of five novel mutations.
Haematologica.
2007;
92
(9)
1186-1193
Reference Ris Wihthout Link
- 28
Tonelli R, Scardovi A L, Pession A et al..
Compound heterozygosity for two different amino-acid substitution mutations in the
thrombopoietin receptor (c-mpl gene) in congenital amegakaryocytic thrombocytopenia
(CAMT).
Hum Genet.
2000;
107
(3)
225-233
Reference Ris Wihthout Link
- 29
Maserati E, Panarello C, Morerio C et al..
Clonal chromosome anomalies and propensity to myeloid malignancies in congenital amegakaryocytic
thrombocytopenia (OMIM 604498).
Haematologica.
2008;
93
(8)
1271-1273
Reference Ris Wihthout Link
- 30
Desai S R, Ranade S R.
Congenital amegakaryocytic thrombocytopenia (CAMT): a case report with review of literature.
Indian J Pathol Microbiol.
2007;
50
(3)
659-660
Reference Ris Wihthout Link
- 31
Steinberg O, Gilad G, Dgany O et al..
Congenital amegakaryocytic thrombocytopenia-3 novel c-MPL mutations and their phenotypic
correlations.
J Pediatr Hematol Oncol.
2007;
29
(12)
822-825
Reference Ris Wihthout Link
- 32
Tamary H, Nishri D, Yacobovich J et al..
Frequency and natural history of inherited bone marrow failure syndromes: the Israeli
Inherited Bone Marrow Failure Registry.
Haematologica.
2010;
95
(8)
1300-1307
Reference Ris Wihthout Link
- 33
Bastida Eizaguirre M, Pereda Vicandi A, Pujana Zaldegui I.
[Congenital amegakaryocytic thrombocytopenia in a 12 year old boy with no signs of
pancytopenia: molecular analysis].
An Pediatr (Barc).
2008;
68
(4)
353-356
Reference Ris Wihthout Link
- 34
Kanaji S, Kanaji T, Migita M et al..
Characterization of a patient with atypical amegakaryocytic thrombocytopenia.
Eur J Haematol.
2008;
80
(4)
361-364
Reference Ris Wihthout Link
- 35
Fox N E, Chen R, Hitchcock I, Keates-Baleeiro J, Frangoul H, Geddis A E.
Compound heterozygous c-Mpl mutations in a child with congenital amegakaryocytic thrombocytopenia:
functional characterization and a review of the literature.
Exp Hematol.
2009;
37
(4)
495-503
Reference Ris Wihthout Link
- 36
Rose M J, Nicol K K, Skeens M A, Gross T G, Kerlin B A.
Congenital amegakaryocytic thrombocytopenia: the diagnostic importance of combining
pathology with molecular genetics.
Pediatr Blood Cancer.
2008;
50
(6)
1263-1265
Reference Ris Wihthout Link
- 37
Frangoul H, Keates-Baleeiro J, Calder C et al..
Unrelated bone marrow transplant for congenital amegakaryocytic thrombocytopenia:
report of two cases and review of the literature.
Pediatr Transplant.
2010;
14
(4)
E42-E45
Reference Ris Wihthout Link
- 38
Chung H S, Koh K N, Kim H J et al..
A novel nonsense mutation in the MPL gene in congenital amegakaryocytic thrombocytopenia.
Pediatr Blood Cancer.
2011;
56
(2)
304-306
Reference Ris Wihthout Link
- 39
Conde N, Quintero A E, Rives S et al..
Congenital amegakaryocytic thrombocytopenia (CAMT): a difficult early diagnosis.
Haematologica.
2010;
95
(Suppl 2)
412-413
Reference Ris Wihthout Link
- 40
Martinón-Torres N, Vázquez-Donsión M, Loidi L, Couselo J M.
CAMT in a female with developmental delay, facial malformations and central nervous
system anomalies.
Pediatr Blood Cancer.
2011;
56
(3)
452-453
Reference Ris Wihthout Link
- 41
Poles A, Keen L, Steward C et al..
Identification of mutations in the C-MPL gene confirms diagnosis of congenital amegakaryocytic
thrombocytopenia (CAMT).
[abstract]
Int J Immunogenet.
2010;
37
(5)
423
Reference Ris Wihthout Link
- 42 Alter B P. Inherited bone marrow failure syndromes. In: Nathan D G, Stranahan R A, Orkin S H, Look A T, Ginsburg D, eds. Nathan and Oski's Hematology of Infancy and Childhood. 6th ed. Philadelphia: Saunders W.B.; 2003: 280-365
Reference Ris Wihthout Link
- 43
Dame C, Wolber E M, Freitag P, Hofmann D, Bartmann P, Fandrey J.
Thrombopoietin gene expression in the developing human central nervous system.
Brain Res Dev Brain Res.
2003;
143
(2)
217-223
Reference Ris Wihthout Link
- 44
Ehrenreich H, Hasselblatt M, Knerlich F et al..
A hematopoietic growth factor, thrombopoietin, has a proapoptotic role in the brain.
Proc Natl Acad Sci U S A.
2005;
102
(3)
862-867
Reference Ris Wihthout Link
- 45
Ivanova A, Wuerfel J, Zhang J, Hoffmann O, Ballmaier M, Dame C.
Expression pattern of the thrombopoietin receptor (Mpl) in the murine central nervous
system.
BMC Dev Biol.
2010;
10
77
Reference Ris Wihthout Link
- 46
Hoffmann O, Rung O, Im A R et al..
Thrombopoietin contributes to neuronal damage in experimental bacterial meningitis.
Infect Immun.
2011;
79
(2)
928-936
Reference Ris Wihthout Link
- 47
Khabbaze Y, Karayalcin G, Paley C, Shende A, Valderrama E, Lipton J M.
Thrombocytopenia absent corpus callosum syndrome: third case of a distinct clinical
entity.
J Pediatr Hematol Oncol.
2001;
23
(7)
469-471
Reference Ris Wihthout Link
- 48
Knight S W, Heiss N S, Vulliamy T J et al..
Unexplained aplastic anaemia, immunodeficiency, and cerebellar hypoplasia (Hoyeraal-Hreidarsson
syndrome) due to mutations in the dyskeratosis congenita gene, DKC1.
Br J Haematol.
1999;
107
(2)
335-339
Reference Ris Wihthout Link
- 49
Geddis A E.
Congenital amegakaryocytic thrombocytopenia and thrombocytopenia with absent radii.
Hematol Oncol Clin North Am.
2009;
23
(2)
321-331
Reference Ris Wihthout Link
- 50
Souyri M, Vigon I, Penciolelli J-F, Heard J M, Tambourin P, Wendling F.
A putative truncated cytokine receptor gene transduced by the myeloproliferative leukemia
virus immortalizes hematopoietic progenitors.
Cell.
1990;
63
(6)
1137-1147
Reference Ris Wihthout Link
- 51
Beer P A, Ortmann C A, Stegelmann F et al..
Molecular mechanisms associated with leukemic transformation of MPL-mutant myeloproliferative
neoplasms.
Haematologica.
2010;
95
(12)
2153-2156
Reference Ris Wihthout Link
- 52
Bagby G C, Meyers G.
Bone marrow failure as a risk factor for clonal evolution: prospects for leukemia
prevention.
Hematology (Am Soc Hematol Educ Program).
2007;
40-46
Reference Ris Wihthout Link
- 53
Roberts I, Stanworth S, Murray N A.
Thrombocytopenia in the neonate.
Blood Rev.
2008;
22
(4)
173-186
Reference Ris Wihthout Link
- 54
Giampietro P F, Verlander P C, Davis J G, Auerbach A D.
Diagnosis of Fanconi anemia in patients without congenital malformations: an international
Fanconi Anemia Registry Study.
Am J Med Genet.
1997;
68
(1)
58-61
Reference Ris Wihthout Link
- 55
Basel-Vanagaite L, Dokal I, Tamary H et al..
Expanding the clinical phenotype of autosomal dominant dyskeratosis congenita caused
by TERT mutations.
Haematologica.
2008;
93
(6)
943-944
Reference Ris Wihthout Link
- 56
Mehta P, Locatelli F, Stary J, Smith F O.
Bone marrow transplantation for inherited bone marrow failure syndromes.
Pediatr Clin North Am.
2010;
57
(1)
147-170
Reference Ris Wihthout Link
- 57
Shimamura A, Alter B P.
Pathophysiology and management of inherited bone marrow failure syndromes.
Blood Rev.
2010;
24
(3)
101-122
Reference Ris Wihthout Link
- 58
Bizzetto R, Bonfim C, Rocha V Eurocord and SAA-WP from EBMT et al.
Outcomes after related and unrelated umbilical cord blood transplantation for hereditary
bone marrow failure syndromes other than Fanconi anemia.
Haematologica.
2011;
96
(1)
134-141
Reference Ris Wihthout Link
- 59
Cocault L, Bouscary D, Le Bousse Kerdiles C et al..
Ectopic expression of murine TPO receptor (c-mpl) in mice is pathogenic and induces
erythroblastic proliferation.
Blood.
1996;
88
(5)
1656-1665
Reference Ris Wihthout Link
- 60
Yan X Q, Lacey D L, Saris C et al..
Ectopic overexpression of c-mpl by retroviral-mediated gene transfer suppressed megakaryopoiesis
but enhanced erythropoiesis in mice.
Exp Hematol.
1999;
27
(9)
1409-1417
Reference Ris Wihthout Link
- 61
Wicke D C, Meyer J, Buesche G et al..
Gene therapy of MPL deficiency: challenging balance between leukemia and pancytopenia.
Mol Ther.
2010;
18
(2)
343-352
Reference Ris Wihthout Link
- 62
Lannutti B J, Epp A, Roy J, Chen J, Josephson N C.
Incomplete restoration of Mpl expression in the mpl-/- mouse produces partial correction
of the stem cell-repopulating defect and paradoxical thrombocytosis.
Blood.
2009;
113
(8)
1778-1785
Reference Ris Wihthout Link
- 63
Heckl D, Wicke D C, Brugman M H et al..
Lentiviral gene transfer regenerates hematopoietic stem cells in a mouse model for
Mpl-deficient aplastic anemia.
Blood.
2011;
117
(14)
3737-3747
Reference Ris Wihthout Link
Matthias BallmaierPh.D.
Pediatric Hematology and Oncology/Molecular Hematopoiesis, OE9411 - J11-H0-1110, Medizinische
Hochschule Hannover
Carl-Neuberg- Strasse 1, D-30625 Hannover, Germany
Email: Ballmaier.Matthias@mh-hannover.de