Lineage switch from precursor B cell acute lymphoblastic leukemia to acute monocytic leukemia at relapse (original) (raw)

Abstract

A lineage switch in leukemia, in which the leukemic cell lineage at onset converts to another lineage at a later time, is an uncommon type of hybrid (mixed) leukemia regarded as a variation of bilineage leukemia. We present a case of a 60-year-old female diagnosed with precursor B cell acute lymphoblastic leukemia (ALL), whose markers in flow cytometry shifted from their original status of CD19+, 22+, 79a+, 13+, HLA-DR+, and TdT+. Although her bone marrow achieved remission after induction therapy, there was a small residual population of leukemic cells in the liver. Residual disease was proved by biopsy and pathologically shown to have an immature phenotype of CD5+, CD10−, CD20−, CD79a− and myeloperoxidase negativity. Two weeks after liver biopsy, blast cells progressively appeared in the peripheral blood; these cells had a monocytoid morphology and phenotype (CD13, 14) but were accompanied by myeloid (CD33) and lymphoid (CD2, 4, 20) cells. Markers CD7, 10 and 19 were negative by flow cytometry. This phenotypical conversion from B-ALL to hybrid leukemia featuring monocytoid characteristics is known as a lineage switch. This case suggests that leukemic subclones tend to carry out de-differentiation, occasionally in extramedullary sites, which serve as a hotbed for the selection of resistant clones.

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Authors and Affiliations

  1. Division of Hematology, Faculty of Medicine, Kagawa University, Kagawa, Japan
    Osamu Imataki & Hiroaki Ohnishi
  2. Department of Laboratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
    Genji Yamaoka, Takeshi Arai & Akira Kitanaka
  3. Department of Transfusion Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
    Yoshitsugu Kubota
  4. Department of Pathology, Kagawa University Hospital, Kagawa, Japan
    Yoshio Kushida
  5. Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
    Toshihiko Ishida
  6. Environmental Health Sciences, Faculty of Medicine, Kagawa University, Kagawa, Japan
    Terukazu Tanaka

Authors

  1. Osamu Imataki
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  2. Hiroaki Ohnishi
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  3. Genji Yamaoka
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  4. Takeshi Arai
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  5. Akira Kitanaka
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  6. Yoshitsugu Kubota
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  7. Yoshio Kushida
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  8. Toshihiko Ishida
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  9. Terukazu Tanaka
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Corresponding author

Correspondence toOsamu Imataki.

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Imataki, O., Ohnishi, H., Yamaoka, G. et al. Lineage switch from precursor B cell acute lymphoblastic leukemia to acute monocytic leukemia at relapse.Int J Clin Oncol 15, 112–115 (2010). https://doi.org/10.1007/s10147-009-0007-3

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