WELCOME TO OUR IFAR FAMILY WEBSITE

 

 

INFORMATION INCLUDED ON THIS SITE:

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IFAR GENERAL INFORMATION FOR FAMILIES NOT YET ENROLLED IN THE IFAR
FANCONI ANEMIA IFAR FORMS
GENETICS OF FANCONI ANEMIA MEDICAL UPDATE FORM
FOR FAMILIES ALREADY ENROLLED IN THE IFAR RESOURCES/LINKS

 

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We asked. You answered. We listened...

Results of our recent study are available!

We are excited to update everyone about the results of our Patient Perspective Study.  In this study, individuals enrolled in the IFAR were invited to participate in an online questionnaire through Survey Monkey to help us learn more about the motivations for participation, experiences with current services, and needs going forward. We thank everyone who participated in the survey for their time and ideas. We couldn't do this work without you and want to do everything possible to maximize your benefits while in the IFAR. Please click here to download our newsletter with all of these results.

 

 

What is the IFAR? Agata

IFAR stands for International Fanconi Anemia Registry.  It is a research study that began at Rockefeller University in New York City in 1982.  The purpose of the IFAR is to study the nature, diagnosis, and treatment of individuals with Fanconi anemia (FA).  We hope that information collected in this study will help researchers better understand FA and be able to better diagnose and treat the condition, which can then directly benefit individuals and families affected by FA.

 

What can the IFAR offer?

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Genetic counseling We have two genetic counselors who can help answer questions you may have about the inheritance of FA, family members that may be at risk, and testing options available to you or your family.  Jennifer Kennedy can be reached at 212-327-8612 and Erica Sanborn can be reached at 212-327-8613. 

Support We know what a hard journey this can be for families.  We want to take this journey with you as much as we can and support you through it.

Knowledge While we recognize that you and your family have become the experts in FA, our team is made up researchers engrossed in the FA world.  We are available to help answer questions you may have at any time.

Establish connections If you are not in touch with other FA families and would like to be, we can help you get connected. If you are looking for a physician/genetic counselor in your local area who is knowledgeable about FA, we can try to assist.

Up-to-date information Please check back often as we will update this page with study information and other relevant FA news and resources. If you have ideas for information that you would like to have covered here please contact Jennifer or Erica.

 

What information will participation in the IFAR provide? 

At this time our laboratory, headed by Agata Smogorzewska, MD, PhD, is a research laboratory.  This means that the information we find cannot be directly released to your family or your doctor.  However, we strive to find the genetic cause of FA in every family who participates.  If we find the causative FA gene and/or which genetic changes/mutations are present, we will work with you and your doctor to confirm the information so it can be shared with you.  The clinical/confirmational testing is ordered by your doctor, will have a cost associated, will require a new DNA sample, but can produce a report that can go in your (your child's) medical chart at your doctor's office and be used by other family members for carrier testing. Having clinical confirmational testing is not a requirement of participation in the IFAR. This is an independent decision and will not affect your ability to participate. This confirmational process of research results applies to all testing performed through our study from July 2009, until the present.  Before that time the IFAR maintained a clinical "CLIA-approved laboratory" at The Rockefeller University Hospital, certified by the New York State Department of Health, with Arleen D. Auerbach, PhD, FACMG, as Laboratory Director.  This means that findings from most mutation testing done before July, 2009 does not need to be confirmed.  Reports from testing before this time can be generated by Dr. Auerbach, upon request through our genetic counselors, and must be sent to a health care professional.

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What is Fanconi anemia?     

Fanconi anemia (FA) is a genetic disease that occurs in approximately 1-2/100,000 live births. FA is a bone marrow failure syndrome.  In addition, major physical abnormalities occur in approximately two out of three cases. The types of birth defects and severity of birth defects vary greatly from patient to patient.  Some of the more common physical abnormalities include: skin pigmentation (55%), short stature (51%), arms (43%), kidney (21%), ears/hearing (9%), heart and lungs (6%), and digestive system (5%). FA is also a cancer susceptibility syndrome.  Individuals with FA have an 800-fold risk to develop AML (or acute myeloid leukemia) and a 500-fold risk to develop solid tumors of the head, neck, genital, and anal regions compared to individuals without FA.

 

Genetics of Fanconi anemia:

Our genetic information, or DNA, is organized on chromosomes.  We each have 46 chromosomes, 23 that come from our mom and 23 from our dad. On each chromosome we have thousands of genes.  Because we also receive one gene copy from mom and one from dad, we have 2 copies of each gene.  In total, we all have about 25,000 different genes in our bodies.  Of these genes, 16 are known to be related to FA.  These genes are on many different chromosomes.  

karyotype with FA genes

Everyone has the 16 FA genes in their bodies, but the difference between individuals with and without FA is whether the genes are working properly.  When an individual has 2 non-working copies of the same FA gene, he/she is considered to have FA (shown in red below). When an individual has 1 working copy and 1 non-working copy of the same FA gene, he/she is considered to be a carrier (shown in purple below).  When an individual has 2 working copies of all of their FA genes, they are unaffected (shown in blue below). 

AR PicIn most cases, FA is a recessive disorder. Meaning that most children with FA have 2 non-working copies of the same FA gene, one that they inherited from their mother and the other from their father.  The parents of children with FA are said to be carriers. Most carriers show no signs or symptoms of FA but are at increased risk to have a child with FA.  When both parents are carriers of a genetic change or mutation in the same FA gene, they have 3 possible outcomes in each future pregnancy.  There is a 25% chance to have an unaffected child; a 50% chance of having a carrier, similar to the parents themselves; and a 25% chance of having a child with FA.  With each pregnancy, these risks are the same, regardless of what happened in a previous pregnancy.

The FA genes are designated by a letter of the alphabet.  The most common gene is FANCA and accounts for approximately 65% of cases.  FANCC and FANCG are the two next most common FA genes.  FANCB is the only gene known to be inherited in a different way and affects mostly boys.  The other FA genes include: FANCD1, FANCD2, FANCE, FANCF FANCI, FANCJ, FANCL, FANCM, FANCN, FANCO, FANCP, and FANCQ. Gene Pie Chart

Of these 16 genes, 8 join together in what is called the "core complex".  These 8 genes include FANCA, FANCB, FANCC, FANCE, FANCF, FANCG, FANCL, and FANCM. There is also a second grouping among the FANCD2 and FANCI genes, which is called the "ID complex".

When parents are both carriers of different non-working FA genes, there is no increased risk to have a child with FA. However, members of their family, including their children would be at increased risk to be a carrier of FA, and therefore at increased risk to have a child affected by FA. For example, if a woman is a carrier of a mutation in FANCA and her partner is a carrier of a mutation of FANCC (and the child inherited both of these mutations), the child would not have FA.  Along these lines, if two individuals with FA conceive a child together, we would only expect the child to have FA if both individuals had the same non-working gene causing their FA.

 

Testing for Fanconi anemia: The testing for FA can be quite complicated. It usually involves at least 2 different steps:

 DEB Full            Sequencing             

                                  DEB Test: Non-FA on left, FA on right                                   Specific Gene Sequencing

 

Each test described above has benefits and limitations. We have summarized some of those benefits and limitations in the table below.  The time it takes to get results and the associated costs are specific to each laboratory and are always changing.  This information is to give you a general estimate but actual time and cost may be higher or lower when the test is ordered.  It is important that the right test be ordered to ensure proper diagnosis and medical management. This testing can be very confusing to doctors and families alike.  We are always happy to speak with your/your child's doctor to help navigate this process if it would be beneficial.

Test Purpose of test
Approx time to get results
Approx Cost Cons/Limitations
Panel testing/ Next generation sequencing

-Find variations/mutations in any FA gene
-Search for new FA genes

 6-10 Weeks $4-5,000

-Cost
-May get results we do not know how to interpret
-Cannot find deletions/ duplications in some labs

Targeted mutation analysis Determine if a known mutation is present or absent 1-3 Weeks $200 per mutation -Only helpful if the mutation is known in the family or the family is of a specific ethnic background
Single gene sequencing Find variations/mutations in any single FA gene 2-4 Weeks $400- $1800 per gene -Can be costly and take a lot of time if complementation testing is not done first
-Cannot find deletions or duplications
Dosage testing (CGH/MLPA) Find any deletions (missing DNA) or duplications (extra DNA) in any FA gene 3-4 Weeks $800- $1500 total -Cannot find misspellings in the DNA
Complementation  Identify which gene is causing the FA  6 Months $2500 for 3 genes -Requires cell line
-May require skin biopsy
-May not work for all patients 

Within each category, testing can be either clinical or research. You can pursue both research testing and clinical testing at the same time.

Clinical testing: This refers to testing that is performed in a "CLIA-approved" laboratory. CLIA laboratories follow very specific laws and regulations.  By law, these clinical laboratories can produce a report with the results of the testing.  The primary goal in clinical testing is to gain information for the patient/family.  The benefits of clinical testing are that it is done much faster (and you can know how long it will take before the test is ordered) and it produces a report that can be shared with physicians and family members.  The limitation of clinical testing is that it can often be expensive and only a few labs may do the desired test. 

Research testing: By law, results from research testing cannot be shared with the patient/family and sometimes even the doctor.  If you would like results from research testing, it has to first be confirmed in a clinical lab.  The primary goal in research testing is to learn more from a science standpoint and not necessarily to benefit the patient/family directly.  So why does anyone do research testing?  Sometimes, a test is only available in a research setting.  Other times, it saves money as all of the research testing is done for free and helps make the clinical testing more meaningful or informative. Finally, the hope is that the research will help us understand FA better so that we can help the FA community as a whole in the future.  The downside of research testing is that it can take a long time and we cannot predict how long it might take.  Here, at The Rockefeller University, we currently do research testing only.

 

FOR INDIVIDUALS ALREADY ENROLLED IN THE IFAR 

Thank you for your participation in the IFAR.  We could not do this study without you! But we still need your help!!!  Currently, we have approximately 1265 families involved in the IFAR, which is wonderful. However, it makes keeping track of the most up-to-date information about each family difficult.  The research only works if the communication is two ways.  We want to help you, and we also need your help.

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Here are ways you could help us:

 

How to contact/update us:

FB logo    FACEBOOK: Please "friend" us as our IFAR Facebook account allows for regular communication with families

 

Email logo   EMAIL: Jennifer: jkennedy@rockefeller.edu; Erica: esanborn@rockefeller.edu

Phone PHONE: Jennifer: 212-327-8612; Erica: 212-327-8613

med upMEDICAL UPDATE FORM: This is a fast, confidential way of providing basic medical information to us. click here to access the form

 

For participating families who have not yet received notification that we have research results available, we greatly appreciate your patience. We know this is a very long and often frustrating wait.  If at any point you are looking for an update or want to check with us to see if any results are available, please do not hesitate to contact Erica Sanborn or Jennifer Kennedy.  Please remember, if we have results that were reported after July 2009, we will not be able to give you the details of the findings until they are confirmed in a clinical laboratory.  However, we will update you about the status and next steps. 

 

FOR INDIVIDUALS NOT YET ENROLLED IN THE IFAR:

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Who can participate in the IFAR? As the name suggests, we are an international registry.  As such, any individual who has been diagnosed with FA, or has features similar to FA is able to participate.  In addition, we like to enroll family members of that individual when possible, as we know genetic testing is most informative when an affected individual and his/her parents are studied at the same time.

What is involved in participation in the IFAR? For all individuals with FA (or FA-like symptoms) in the IFAR we collect medical information and often a DNA sample (DNA is the genetic information in our bodies).  The medical information we collect is from medical professionals and family members, where appropriate.  If the genetic cause of FA is already known in your family, then we would not need a DNA sample in most cases.  When we do need a DNA sample, it is usually obtained through a blood draw.  However, if a person has already had a bone marrow transplant, or diagnostic testing for FA has showed ambiguous results, we often try to arrange a skin biopsy as well.  From the DNA sample we create a cell line, which is a group of cells that can live and grow outside of the body.  They can be frozen and can be used for future research.  For family members of someone with FA or FA-like symptoms, we gather relevant medical history and also try to obtain a blood sample to have DNA for the testing. 

 What are the benefits of participating in the IFAR?

What are the risks of participating in the IFAR?

If I/my family is not already enrolled in the IFAR how do we get involved?

 

FORMS YOU MAY NEED FOR IFAR PARTICIPATION:                

 

History of the IFAR: Dr. Auerbach

The IFAR was founded in May 1982, by Dr. Arleen D.  Auerbach, in collaboration initially with Dr. Traute Schroeder-Kurth of Germany. Schroeder-Kurth, in 1964, discovered the chromosome instability in Fanconi anemia patients and Auerbach, in 1981, developed the DEB (diepoxybutane) chromosome breakage test.   From May 1982 until closing in December 2007, Auerbach’s Cytogenetics Laboratory at The Rockefeller Hospital was New York State licensed and CLIA-certified. The laboratory issued diagnostic reports on many patients from North America with clinical findings resembling FA.  Patients with a positive DEB test were eligible to participate in the IFAR study, resulting in the enrollment of a large number of patients with FA. Studies of IFAR patients led to the discovery that the clinical features of the syndrome were much more varied than originally thought, and to the recognition of the need for a more timely diagnosis of the disease.  The IFAR Tissue Repository of specimens from patients with a positive DEB test aided researchers over the years to identify new genes for FA, and to find a large spectrum of changes in these genes that cause the disease (click here for IFAR publications).  In 2011, Agata Smogorzewska, M.D., Ph.D. Head of the Laboratory of Genome Maintenance at the Rockefeller University became the Principal Investigator of the IFAR, with Auerbach remaining as an Investigator on the IFAR protocol and Consultant to the Laboratory of Genome Maintenance.

 

RESOURCES/LINKS: 

 

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