Leukemia with Multiple Phenotypic Expressions

Abstract

A patient is described who, during a three-year illness, exhibited multiple phenotypic expressions of leukemia. She was diagnosed initially as having acute lymphoblastic leukemia (ALL) followed by chronic myelogenous leukemia (CML) one and a half years later. Subsequent blast transformations were lymphoblastic, but preterminally, a myeloblastic transformation occurred. These later leukemias probably were not chemotherapy induced, because a review of her initial work-up revealed the presence of a smaller G group chromosome in 1 of 20 metaphases examined. Her clinical course also differs from the CML that presents in lymphoid blast crisis because the Philadelphia chromosome only was emerging at that point. This case illustrates the interrelationships of the various leukemias and supports the hypothesis that a totipotent stem cell may undergo leukemic transformation resulting in variable and simultaneous expressions.

Chronic Myelogenous Leukemia Presenting as a Secondary Malignancy After BCR-ABL1-negative B-lymphoblastic Leukemia/Lymphoma in a Pediatric Patient

“…7 Other, earlier case reports that purportedly described patients presenting with initial Ph(À) ALL diagnoses, followed by CML being detected at a later time, are questionable because of the limitations in ancillary techniques available for a complete workup; 8 lack of cytogenetic information at the time of ALL diagnosis; 9 questionable diagnosis of CML, due to lack of the characteristic t(9;22) translocation; 10,11 and/or the presence of a Ph chromosome at the time of ALL diagnosis, which favors an interpretation of lymphoblastic BP CML (rather than de novo ALL). 12,13 CML can occur as a secondary neoplasm following exposure to radiation and/or chemotherapy. Of 33 published cases of therapy-related CML, 14,15 the majority occurred in adults with a history of classical Hodgkin lymphoma (median age, 43 years; range: 11-70 years).…”