Lineage switch from acute myeloid leukemia to acute lymphoblastic leukemia: Report of an adult case and review of the literature

Lounici, A; Cony‐Makhoul, Pascale; Dubus, Pierre; Lacombe, Francis; Merlio, J.P.

doi:10.1002/1096-8652(200012)65:4<319::aid-ajh13>3.0.co;2-1

Cited by 25 publications

(11 citation statements)

References 7 publications

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“…Several hypotheses have been proposed to explain lineage switches in acute leukemia [13, 15-17]. According to the common myeloid/lymphoid progenitor cell hypothesis, uncommitted progenitor cells that have both early myeloid and T- or B-lymphoid markers lose 1 lineage marker during the maturation process and differentiate toward the other lineage [15].…”

Section: Discussionmentioning

confidence: 99%

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Erythroleukemia Relapsing as Precursor B-cell Lymphoblastic Leukemia

Park

Jang

et al. 2011

Ann Lab Med

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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.

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Section: Discussionmentioning

confidence: 99%

“…This hypothesis has been supported by the spontaneous lineage switches in the blast transformation phase of chronic myeloid leukemia [16]. According to the primary chemotherapy-related hypotheses, the predominant leukemic clone may be suppressed by chemotherapy, allowing the expansion of subclones with different phenotypes [13, 17]. …”

Section: Discussionmentioning

confidence: 99%

Erythroleukemia Relapsing as Precursor B-cell Lymphoblastic Leukemia

Park

Jang

et al. 2011

Ann Lab Med

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“…Discordant immunophenotype between leukemia biopsied at multiple time points or at different sites has been well documented in the literature . Rare cases of acute leukemia have been reported showing ‘lineage switching’, in which the leukemic cell from lymphoblastic lineage at onset converts to myeloid lineage at a later time, or vice versa . These phenomena suggest that lineage heterogeneity may exist in some acute leukemia cases.…”

Section: Discussionmentioning

confidence: 94%

Extramedullary acute leukemia developing in a pre‐existing osteoma cutis

Wang¹,

O’Malley

2014

J Cutan Pathol

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Primary osteoma cutis (cutaneous ossification) is an uncommon disease in which there is bone formation within the skin in the absence of a demonstrable pre-existing condition. Osteoma cutis is a chronic and benign condition. We report a case of a 45-year-old man who developed extramedullary acute leukemia with a myeloid immunophenotype (myeloid sarcoma) with its initial presentation within an isolated pre-existing osteoma cutis in the post-auricular scalp without evidence of systemic acute leukemia or chronic myeloid stem cell disorders. The tumor was surgically excised without complications. Four months later, acute leukemia recurred in the contralateral posterior mandible and showed an immunophenotype consistent with acute lymphoblastic leukemia/lymphoma. The patient now has been treated by standard protocols for acute leukemia. The diagnosis of an extramedullary acute leukemia is challenging because of its inconsistent clinical and histopathologic presentations. Extramedullary acute leukemia developing in a pre-existing osteoma cutis is very unusual and has not been previously reported in the literature.

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“…There are several previous reports on lineage switch that in Ph chromosome-positive acute leukemia. [7][8][9][10][11][12][13][14] Blast lineage switch has been shown to be related to clonal selection and transformation of multipotent progenitor cells during chemotherapy; 8 however, lineage switch is rare in CML-BC. Lineage switch often occurs during conventional chemotherapy, although in this case, the switch occurred during treatment with imatinib.…”

Section: Discussionmentioning

confidence: 99%

<p>Myeloid Blast Crisis of Chronic Myeloid Leukemia Followed by Lineage Switch to B-Lymphoblastic Leukemia: A Case Report</p>

Liu

Zhou

Yuan

et al. 2020

OTT

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Lineage switch is very rare in blastic crisis of chronic myeloid leukemia (CML-BC). Here, we report a case of CML-BC in which the blast lineage switched from myeloid to B-lymphoid. A 35-year-old male was initially admitted to our hospital because of abdominal distention for over a year and dizziness for one week. Prior to presentation at our hospital, he visited a local hospital because of abdominal distention where his white blood cell count and bone marrow (BM) smear indicated CML. Results from peripheral blood (PB) counts, bone marrow analysis, immunophenotyping by flow cytometry, and the detection of the Philadelphia chromosome were consistent with a diagnosis of myeloid blast crisis from CML. The patient received chemotherapy with imatinib for induction, which diminished the number of blasts. However, after three months, the blasts were increased in the PB and BM. The BM study and immunophenotyping by flow cytometry revealed B-lymphoblastic leukemia. In accordance with his first admission, a chromosome study revealed a karyotype of 46, XY, t(9; 22)(q34; q11) in all 20 cells analyzed, and B-lymphoblastic transformation from CML was diagnosed. Despite three months of treatment with DVCP (daunorubicin, vincristine, cyclophosphamide and prednisone) chemotherapy in combination with dasatinib, the patient did not achieve complete remission. The patient decided to stop treatment and was discharged from the hospital for financial reasons. This case implicates the Philadelphia chromosome with p210 BCR-ABL1 fusion proteins as a key molecule in CML-BC. Further research is needed to assess the frequency, treatment, and prognosis of CML-BC patients with lineage switch.

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Lineage switch from acute myeloid leukemia to acute lymphoblastic leukemia: Report of an adult case and review of the literature

Cited by 25 publications

References 7 publications

Erythroleukemia Relapsing as Precursor B-cell Lymphoblastic Leukemia

Erythroleukemia Relapsing as Precursor B-cell Lymphoblastic Leukemia

Extramedullary acute leukemia developing in a pre‐existing osteoma cutis

<p>Myeloid Blast Crisis of Chronic Myeloid Leukemia Followed by Lineage Switch to B-Lymphoblastic Leukemia: A Case Report</p>

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