Erythroleukemia Relapsing as Precursor B-cell Lymphoblastic Leukemia

Abstract

AML relapsing as ALL has rarely been reported. We describe the case of a 62-yr-old man who was diagnosed with erythroleukemia with a complex karyotype and achieved complete hematologic and cytogenetic remission after induction chemotherapy. However, 4 months after the initial diagnosis, he showed relapse with blasts showing a different morphology and immunophenotype and was diagnosed with precursor B-cell ALL. The relapsing precursor B-cell ALL presented with the same leukemic clones as the primary erythroleukemia. Cytogenetic analysis of his bone marrow (BM) at the time of the primary erythroleukemia showed complex karyotypic abnormalities, including monosomy 5 and monosomy 7. At relapse, his BM showed reemergence of these leukemic clones of complex karyotypic abnormalities with clonal switch. To our knowledge, this is the first case of a lineage switch from erythroleukemia to ALL.

Double Lineage Switch from Acute Megakaryoblastic Leukemia (AML-M7) to Acute Lymphoblastic Leukemia (ALL) and Back Again: A Case Report

“…Similar case was reported as clonal rearrangements of the Ig heavy chain gene locus both in B cell ALL and subsequent AML cells [12]. The case of conversion from B cell lymphoblastic leukemia to erythroleukemia has complex karyotypic abnormalities in addition of original monosomy 5 and monosomy 7 [13]. chemotherapy could modify the original leukemic clone by amplifying or suppressing the differentiation programs, resulting in a lineage switch.…”

“…Cases of conversions from AML to ALL and vice versa are extremely rare [1][2][3][4][5][6][7][8][9][10][11][12][13]. Several hypotheses have been suggested to explain lineage conversion in leukemias, but the precise mechanism remains unclear.…”

Tracing Dynamics and Clonal Heterogeneity of Cbx7-Induced Leukemic Stem Cells by Cellular Barcoding

“…Conversions from AML to ALL occur less frequently, but have been reported for both children and adults ( Bernstein et al., 1986; Boeckx et al., 2004; Dorantes-Acosta et al., 2009; Emami et al., 1983; Krawczuk-Rybak et al., 2003; Lounici et al., 2000; Marcus et al., 1985; Rossi et al., 2012 ). Case reports of other types of leukemic conversions, such as erythroid leukemia into ALL, have also been published ( Park et al., 2011 ). In leukemic patients showing a relapse of a different lineage (so-called lineage switch), leukemic clones often have a different morphology, cell size, amount of cytoplasm, presence of Auer rods, and new phenotypic lineage markers ( Park et al., 2011; van den Ancker et al., 2009 ).…”

Control of Lineage Commitment in Acute Leukaemia

“…Complex karyotypes on presentation and relapse indicated that the ALL was from the same clone with the AML. [97] These collected reports showed rearrangement on 11q23 occurred on a high number of the cases.…”

“…Among these 6 lineage switch cases, 5 cases were a conversion from ALL to AML, and 1 case was the reverse. In addition to its rare evidence, the reports [84,[86][87][88][89][90][91][92][93][94][95][96][97] also showed that the disease had a very poor prognosis with no standard treatment (most cases were resistant to chemotherapy at relapse). Conversion from ALL to AML forms the majority of cases and predominantly occurred in children.…”