Korean J Lab Med.  2007 Apr;27(2):102-105. 10.3343/kjlm.2007.27.2.102.

A Case of Lineage Switch from Acute Lymphoblastic Leukemia to Acute Myeloid Leukemia

• Chung HJ
• Park CJ
• Jang S
• Chi HS
• Seo EJ
• Seo JJ

• KMID: 1781467
• DOI: http://doi.org/10.3343/kjlm.2007.27.2.102

Abstract

Lineage switch from acute lymphoblastic leukemia (ALL) to acute myeloid leukemia (AML) is very rare. We report a case of a 9 yr-old ALL patient relapsed as acute myelomonocytic leukemia. At the initial diagnosis, the blast cell morphology and immunophenotype were consistent with the diagnosis of typical ALL (L1 subtype according to FAB classification). The BCR-ABL fusion gene was not found by reverse transcription-PCR. Complete remission (CR) was achieved after induction and consolidation chemotherapy (Children's Cancer Study Group 1891 protocol, CCG1891). Nine months, which is a very short time compared with other cases in the literatures, after the diagnosis of ALL, she relapsed with completely different blasts (typical AML, M4 according to FAB classification) in morphology, cytochemistry, and immunophenotyping. The karyotype has changed from 56,XY,+X,+Y,+Y,+4,+8,+10, +14,+17,-20,+21,+21,+21[6]/57,idem,+Y[19] to 46,XY,t(8;16)(p11.2;p13.1)[19]/46,XY[1], showing unrelated chromosomal abnormality to the karyotype at the initial diagnosis. Moreover, both findings were quite specific for each common cell ALL and acute myelomonocytic leukemia. These findings support that this case is completely different leukemic clones occurred at each leukemic expression. The treatment with AML 2000 protocol chemotherapy failed, and he underwent the chemotherapy with the combination of high dose cytarabine and mitoxantrone and has been in CR state for 21 months, until now.

Keyword

Lineage switch; Acute lymphoblastic leukemia; Acute myelomonocytic leukemia

MeSH Terms

*Cell Lineage
Cell Transformation, Neoplastic
Child
Humans
Karyotyping
Leukemia, Myeloid, Acute/*diagnosis/pathology
Male
Precursor Cell Lymphoblastic Leukemia-Lymphoma/*diagnosis/pathology

Figure

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  Fig. 1. Bone marrow aspirate findings (Wright stain, ×1,000) (A) Acute lymphoblastic leukemia at the initial diagnosis, (B) Acute myelomonocytic leukemia at the relapse.

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  Fig. 2. The change of karyotype with bone marrow aspirates. (A) The karyotype at the diagnosis of acute lymphoblastic leukemia revealed 56,XY,+X,+Y,+Y,+4,+8,+10,+14,+17,-20,+21,+21,+21[6]/57,idem,+Y[19]. (B) The karyotype at the relapse as acute myelomonocytic leukemia revealed 46,XY,t(8;16)(p11.2;p13.1)[19]/46,XY[1] showing unrelated abnormality to the karyotype at the initial diagnosis.

Reference

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