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This is an autosomal dominant disorder caused by mutations in the RUNX1 gene and is characterized by mild to moderate thrombocytopenia, platelet functional and/or ultrastructural defects and a predisposition to hematologic malignancies, most often AML and MDS, and less frequently T-ALL.
Features include always present findings: Abnormal dense granule content, Impaired platelet aggregation, Prolonged bleeding time, and Ecchymosis and others; and sometimes findings: Acute myeloid leukemia. 19 total HPO annotations.
Organ System | Phenotype Count | Example Features |
|---|---|---|
Blood and immune system | 8 | Impaired platelet aggregation, Prolonged bleeding time, Abnormal platelet shape |
To date, more than 130 individuals have been identified with a germline pathogenic variant in RUNX1 . The following description of the phenotypic features associated with RUNX1 familial platelet disorder with associated myeloid malignancies (RUNX1-FPDMM) is based on these reports. Table 2. RUNX1 Familial Platelet Disorder with Associated Myeloid Malignancies: Frequency of Select Features
Feature | % of Persons w/Feature | Comment |
|---|---|---|
Prolonged bleeding /or easy bruising | ~90% | Presentation can be variable. |
Myelodysplastic syndrome / acute myeloid leukemia | ~20%-50% | , |
Lymphoid malignancy | Unknown | ~25% of families have at least 1 member w/lymphoid malignancy . |
Eczema | Up to 50% | Prolonged bleeding. Almost all individuals with RUNX1-FPDMM will experience some degree of abnormal bleeding as a consequence of their quantitative and/or qualitative platelet defect at some point. The bleeding phenotype may be highly variable, even within families. |
Source: GeneReviews — "RUNX1 Familial Platelet Disorder with Associated Myeloid Malignancies"
RUNX1 function has not been fully characterized.
Hereditary thrombocytopenia and hematological cancer predisposition syndrome associated with RUNX1 is associated with mutations in the RUNX1 gene on chromosome 21.
No consistent clinically relevant genotype-phenotype correlations have been identified.
Source: GeneReviews — "RUNX1 Familial Platelet Disorder with Associated Myeloid Malignancies"
The penetrance of germline RUNX1 pathogenic variants is unknown. A minority of individuals have no clinical or laboratory features.
Source: GeneReviews — "RUNX1 Familial Platelet Disorder with Associated Myeloid Malignancies"
RUNX1 familial platelet disorder with associated myeloid malignancies (RUNX1-FPDMM) should be suspected in individuals with the following findings.
Clinical findings
Abnormal bruising or bleeding (90%)
Bruising without known trauma
Excessive bleeding following surgery or trauma
Bleeding from the gums after brushing or flossing teeth or prolonged bleeding following dental cleaning or dental extractions
Obstetric and gynecologic manifestations may include menorrhagia, miscarriage, and bleeding before or after childbirth.
20%-25% of individuals require platelet transfusions or medications to assist primary hemostasis such as antifibrinolytics (e.g., tranexamic acid, aminocaproic acid).
Hematologic malignancy (up to 50%)
Eczema (up to 50% of families)
Family history
Source: GeneReviews — "RUNX1 Familial Platelet Disorder with Associated Myeloid Malignancies"
Table 3.
RUNX1 Familial Platelet Disorder with Associated Myeloid Malignancies: Differential Diagnosis
Gene | DiffDx Disorder | MOI | Clinical Features of DiffDix Disorder
Overlapping w/RUNX1-FPDMM | Distinguishing from RUNX1-FPDMM
| ANKRD26-related thrombocytopenia | AD | Nonsyndromic thrombocytopenia w/normal platelet size predisposition to myeloid neoplasms | Some persons may have erythrocytosis (hemoglobin ≤18.5 g/dL) leukocytosis.
| CEBPA-associated familial acute myeloid leukemia | AD | Familial predisposition to AML thrombocytopenia | Leukopenia (w/ infections) anemia
| DDX41-associated familial MDS/AML | AD | Familial predisposition to MDS/AML | Some persons may have erythroid or megakaryocytic dysplasia.1
Source: GeneReviews — "RUNX1 Familial Platelet Disorder with Associated Myeloid Malignancies"
Genetic testing for RUNX1 is available. Testing is considered confirmatory for diagnosis.
No approved treatments are currently available for hereditary thrombocytopenia and hematological cancer predisposition syndrome associated with RUNX1. The disease remains an area of unmet medical need.
No clinical practice guidelines for RUNX1 familial platelet disorder with associated myeloid malignancies (RUNX1-FPDMM) have been published.
To establish the extent of disease and needs in an individual diagnosed with RUNX1-FPDMM, the evaluations summarized (if not performed as part of the evaluation that led to the diagnosis) are recommended.
Table 4.
Recommended Evaluations Following Initial Diagnosis in Individuals with RUNX1 Familial Platelet Disorder with Associated Myeloid Malignancies
System/Concern | Evaluation | Comment
| Clinical eval by hematologist incl CBC, differential, reticulocyte count, peripheral smear | Baseline bone marrow biopsy aspirate may be considered.
| Clinical eval for eczema or other skin concerns as needed |
Genetic
counseling | By genetics professionals1 | To obtain a pedigree inform affected persons their families re nature, MOI, implications of RUNX1-FPDMM to facilitate medical personal decision making
CBC = complete blood count; MOI = mode of inheritance; RUNX1-FPDMM = RUNX1 familial platelet disorder with associated myeloid malignancies
1. Clinical geneticist, certified genetic counselor, certified genetic nurse, genetics advanced practice provider (nurse practitioner or physician assistant), or hematologist with expertise in these disorders
Treatment of Manifestations
Table 5.
Treatment of Manifestations in Individuals with RUNX1 Familial Platelet Disorder with Associated Myeloid Malignancies
Source: GeneReviews — "RUNX1 Familial Platelet Disorder with Associated Myeloid Malignancies"
Avoid the following:
Medications that affect platelet function, such as NSAIDs and antiplatelet agents
Activities with a high risk of trauma, such as high-risk contact sports
Factors such as smoking, chemical exposure, unnecessary radiation, and obesity may increase the risk of developing hematologic malignancy.
Source: GeneReviews — "RUNX1 Familial Platelet Disorder with Associated Myeloid Malignancies"
The NIH RUNX1 Natural History Study (NCT03854318) is currently recruiting participants with known or suspected RUNX1-FPDMM. The goals of the study are to better understand the natural history of the condition and its underlying genetic mechanisms to develop better strategies for monitoring and treating affected individuals . Search ClinicalTrials.gov in the US and EU Clinical Trials Register in Europe for access to information on clinical studies for a wide range of diseases and conditions.
Source: GeneReviews — "RUNX1 Familial Platelet Disorder with Associated Myeloid Malignancies"
View trials for hereditary thrombocytopenia and hematological cancer predisposition syndrome associated with RUNX1
Guidelines on the type of testing or frequency of surveillance have not been published.
Table 6.
Recommended Surveillance for Individuals with RUNX1 Familial Platelet Disorder with Associated Myeloid Malignancies
System/Concern | Evaluation | Frequency
Hematologic
malignancy | Clinical exam for constitutional signs symptoms of neoplasm (e.g., fatigue, unexplained fever, unexplained weight loss, shortness of breath) | Every 6-12 mos or more frequently as clinically indicated
CBC w/differential | Every 3-4 mos
Bone marrow exam | • If constitutional symptoms /or abnormalities on CBC are identified
Consider annually (although there is no consensus on this recommendation).
| Skin exam | As needed
CBC = complete blood count
Source: GeneReviews — "RUNX1 Familial Platelet Disorder with Associated Myeloid Malignancies"
Phenotype severity distribution: 11 always present features.
No clinical trials have been registered for hereditary thrombocytopenia and hematological cancer predisposition syndrome associated with RUNX1.
7 publications have been identified in PubMed for hereditary thrombocytopenia and hematological cancer predisposition syndrome associated with RUNX1. Research spans Epidemiology / Natural History (50%), Review / Meta-Analysis (33%), and Case Report / Case Series (17%).
Kajdic A (2026). [PMID: 41616279](https://pubmed.ncbi.nlm.nih.gov/41616279/). *Blood Adv*. [Epidemiology / Natural History]
Glonnegger H (2025). [PMID: 41458504](https://pubmed.ncbi.nlm.nih.gov/41458504/). *Front Med (Lausanne)*. [Case Report / Case Series]
Tesi B (2025). [PMID: 40388595](https://pubmed.ncbi.nlm.nih.gov/40388595/). *Clin Cancer Res*. [Epidemiology / Natural History]
Ernst MPT (2025). [PMID: 39822584](https://pubmed.ncbi.nlm.nih.gov/39822584/). *Hemasphere*. [Epidemiology / Natural History]
Kotmayer L (2025). [PMID: 40568716](https://pubmed.ncbi.nlm.nih.gov/40568716/). *Haematologica*. [Review / Meta-Analysis]
Trottier AM (2025). [PMID: 40563019](https://pubmed.ncbi.nlm.nih.gov/40563019/). *Curr Oncol Rep*. [Review / Meta-Analysis]
Data assembled from 6 of 12 sources · Last updated Sep 20, 2026, 11:36 PM UTC
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