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Yang W, Xie S, Li Y, Wang J, Xiao J, Huang K, Wang X, Wu Y, Ma L, Nie D. Lineage switch from lymphoma to myeloid neoplasms: First case series from a single institution. Open Med (Wars) 2022; 17:1466-1472. [PMID: 36133509 PMCID: PMC9462540 DOI: 10.1515/med-2022-0521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 06/15/2022] [Accepted: 06/18/2022] [Indexed: 11/15/2022] Open
Abstract
Lymphoma relapse is very common in clinical work, but lineage switch at relapse is rare. Although some cases have reported acute lymphocytic leukemia (ALL) switch to acute myeloid leukemia (AML) or myeloid sarcoma upon relapse, phenotype switch seldom occurs in other types of lymphoma. Here we report six cases with lineage switch from lymphoma to myeloid neoplasms. In our cohort, three cases were mantle cell lymphoma (MCL), and the other three cases were T-cell lymphoblastic lymphoma (T-LBL), B-cell lymphoblastic lymphoma (B-LBL), and diffuse large B-cell lymphoma (DLBCL) at the initial diagnosis. When linage switch occurred, most cases were AML M5 phenotypes, and only one case was myelodysplastic syndrome (MDS) phenotype. 11q23/mixed-lineage leukemia (MLL) rearrangement was negative in all cases. Although intensive therapy and stem cell transplantation have been applied in most cases, the poor outcome cannot be reversed. Therefore, we found that lineage switch could occur not only from ALL to AML or vice versa, but also from MCL or DLBCL to AML. Moreover, the incidence of MLL rearrangement in lineage switch is lower in adult hematologic malignancies as compared with pediatric patients.
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Affiliation(s)
- Wenjuan Yang
- Department of Hematology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou 510120 , PR China
- Department of Hematology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou 510120 , PR China
| | - Shuangfeng Xie
- Department of Hematology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou 510120 , PR China
- Department of Hematology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou 510120 , PR China
| | - Yiqing Li
- Department of Hematology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou 510120 , PR China
- Department of Hematology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou 510120 , PR China
| | - Jieyu Wang
- Department of Hematology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou 510120 , PR China
- Department of Hematology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou 510120 , PR China
| | - Jie Xiao
- Department of Hematology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou 510120 , PR China
- Department of Hematology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou 510120 , PR China
| | - Kezhi Huang
- Department of Hematology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou 510120 , PR China
- Department of Hematology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou 510120 , PR China
| | - Xiuju Wang
- Department of Hematology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou 510120 , PR China
- Department of Hematology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou 510120 , PR China
| | - Yudan Wu
- Department of Hematology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou 510120 , PR China
- Department of Hematology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou 510120 , PR China
| | - Liping Ma
- Department of Hematology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou 510120 , PR China
- Department of Hematology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou 510120 , PR China
| | - Danian Nie
- Department of Hematology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou 510120 , PR China
- Department of Hematology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou 510120 , PR China
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Kurzer JH, Weinberg OK. To B- or not to B-: A review of lineage switched acute leukemia. Int J Lab Hematol 2022; 44 Suppl 1:64-70. [PMID: 35770493 DOI: 10.1111/ijlh.13923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022]
Abstract
Acute leukemia is a heterogeneous disorder of hematologic malignancies composed primarily of hematopoietic precursors that have acquired unregulated self-renewal and proliferation. Hematology classification systems typically divide these neoplasms into lymphoid (B- or T-) and myeloid-lineage subtypes, with therapy dependent upon this distinction. Infrequently, certain acute leukemias may undergo a complete lineage switch at relapse, subsequently complicating the diagnosis and treatment of these recurrent diseases. Transformation from B-lineage to myeloid lineage is the most common switch observed, and is frequently associated with a balanced 11q23 translocation, involving KMT2A. The mechanisms involved in the lineage-switch are unclear, but modern therapies targeting the B-cell-specific marker, CD19, have proven to promote this conversion as one means of treatment escape. Broadly speaking, therapy-mediated selection of alternate lineage-committed subclones derived from the same initial pluripotent progenitors, clonal evolution and reprogramming of lineage-committed blasts, and de novo clonally unrelated leukemias may account for the clinical impression of lineage switched acute leukemia during treatment. This review will explore the phenomenon and potential mechanisms of lineage transformation during the treatment of acute leukemia.
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Affiliation(s)
- Jason H Kurzer
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Olga K Weinberg
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA
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Hu T, Murdaugh R, Nakada D. Transcriptional and Microenvironmental Regulation of Lineage Ambiguity in Leukemia. Front Oncol 2017; 7:268. [PMID: 29164065 PMCID: PMC5681738 DOI: 10.3389/fonc.2017.00268] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 10/23/2017] [Indexed: 01/27/2023] Open
Abstract
Leukemia is characterized by the uncontrolled production of leukemic cells and impaired normal hematopoiesis. Although the combination of chemotherapies and hematopoietic stem cell transplantation has significantly improved the outcome of leukemia patients, a proportion of patients still suffer from relapse after treatment. Upon relapse, a phenomenon termed “lineage switch” is observed in a subset of leukemia patients, in which conversion of lymphoblastic leukemia to myeloid leukemia or vice versa is observed. A rare entity of leukemia called mixed-phenotype acute leukemia exhibits co-expression of markers representing two or three lineages. These two phenotypes regarding the lineage ambiguity suggest that the fate of some leukemia retain or acquire a certain degree of plasticity. Studies using animal models provide insight into how lineage specifying transcription factors can enforce or convert a fate in hematopoietic cells. Modeling lineage conversion in normal hematopoietic progenitor cells may improve our current understanding of how lineage switch occurs in leukemia. In this review, we will summarize the role of transcription factors and microenvironmental signals that confer fate plasticity to normal hematopoietic progenitor cells, and their potential to regulate lineage switching in leukemias. Future efforts to uncover the mechanisms contributing to lineage conversion in both normal hematopoiesis and leukemia may pave the way to improve current therapeutic strategies.
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Affiliation(s)
- Tianyuan Hu
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, United States
| | - Rebecca Murdaugh
- Program in Developmental Biology, Baylor College of Medicine, Houston, TX, United States
| | - Daisuke Nakada
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, United States.,Program in Developmental Biology, Baylor College of Medicine, Houston, TX, United States
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Wu B, Jug R, Luedke C, Su P, Rehder C, McCall C, Lagoo AS, Wang E. Lineage Switch Between B-Lymphoblastic Leukemia and Acute Myeloid Leukemia Intermediated by "Occult" Myelodysplastic Neoplasm: Two Cases of Adult Patients With Evidence of Genomic Instability and Clonal Selection by Chemotherapy. Am J Clin Pathol 2017; 148:136-147. [PMID: 28898985 DOI: 10.1093/ajcp/aqx055] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Lineage switch occurs in rare leukemias, and the mechanism is unclear. We report two cases of B-lymphoblastic leukemia (B-ALL) relapsed as acute myeloid leukemia (AML). METHODS Retrospective review of clinical and laboratory data. RESULTS Complex cytogenetic abnormalities were detected in B-ALL for both cases with subclone heterogeneity. Postchemotherapy marrow biopsies showed trilineage hematopoiesis without detectable B-ALL. Cytogenetics in both showed stemline abnormalities. The cases were considered "occult" myelodysplastic syndrome (MDS) preceding B-ALL. The patients relapsed 6.5 and 9 months following induction, respectively. Case 1 relapsed as AML-M5 initially, was treated as such, and then relapsed again as B-ALL. Case 2 relapsed as AML-M6. Cytogenetics demonstrated persistent abnormalities. Both patients died soon after relapse. CONCLUSIONS Lineage switch between B-ALL and AML could be intermediated by occult MDS. A pluripotent progenitor likely undergoes neoplastic transformation, resulting in a genomically unstable clone. This leads to a repertoire of heterogeneous subclones that may be selected by chemotherapy. Lineage switch heralds a dismal clinical outcome.
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MESH Headings
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cell Transformation, Neoplastic/drug effects
- Cell Transformation, Neoplastic/genetics
- Chromosome Aberrations
- Genomic Instability
- Humans
- Leukemia, B-Cell/genetics
- Leukemia, B-Cell/pathology
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Male
- Myelodysplastic Syndromes/genetics
- Myelodysplastic Syndromes/pathology
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/pathology
- Young Adult
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Affiliation(s)
- Bin Wu
- Division of Hematology, Department of Medicine, Shengjing Hospital affiliated with China Medical University, Shenyang, People's Republic of China
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Rachel Jug
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Catherine Luedke
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Pu Su
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Catherine Rehder
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Chad McCall
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Anand S Lagoo
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Endi Wang
- Department of Pathology, Duke University Medical Center, Durham, NC
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Matern S, Schmidt E, Hartmann D, Schliemann C, Groth C, Lenz G, Hartmann W, Klapper W, Berdel W, Stelljes M. Successful second allogeneic stem cell transplantation in a patient with T-lymphoblastic leukemia (T-ALL) relapsed as myeloid sarcoma. Ann Hematol 2017; 96:1201-1203. [DOI: 10.1007/s00277-017-3000-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/05/2017] [Indexed: 11/28/2022]
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Ruiz-Delgado G, Nuñez-Cortez A, Olivares-Gazca J, Fortiz Y, Ruiz-Argüelles A, Ruiz-Argüelles G. Lineage switch from acute lymphoblastic leukemia to myeloid leukemia. MEDICINA UNIVERSITARIA 2017. [DOI: 10.1016/j.rmu.2017.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Klauke K, Broekhuis MJC, Weersing E, Dethmers-Ausema A, Ritsema M, González MV, Zwart E, Bystrykh LV, de Haan G. Tracing dynamics and clonal heterogeneity of Cbx7-induced leukemic stem cells by cellular barcoding. Stem Cell Reports 2014; 4:74-89. [PMID: 25434821 PMCID: PMC4297865 DOI: 10.1016/j.stemcr.2014.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 10/21/2014] [Accepted: 10/22/2014] [Indexed: 12/31/2022] Open
Abstract
Accurate monitoring of tumor dynamics and leukemic stem cell (LSC) heterogeneity is important for the development of personalized cancer therapies. In this study, we experimentally induced distinct types of leukemia in mice by enforced expression of Cbx7. Simultaneous cellular barcoding allowed for thorough analysis of leukemias at the clonal level and revealed high and unpredictable tumor complexity. Multiple LSC clones with distinct leukemic properties coexisted. Some of these clones remained dormant but bore leukemic potential, as they progressed to full-blown leukemia after challenge. LSC clones could retain multilineage differentiation capacities, where one clone induced phenotypically distinct leukemias. Beyond a detailed insight into CBX7-driven leukemic biology, our model is of general relevance for the understanding of tumor dynamics and clonal evolution.
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Affiliation(s)
- Karin Klauke
- European Institute for the Biology of Ageing (ERIBA), Section Ageing Biology and Stem Cells, University Medical Centre Groningen, University of Groningen, Groningen 9700 AD, the Netherlands.
| | - Mathilde J C Broekhuis
- European Institute for the Biology of Ageing (ERIBA), Section Ageing Biology and Stem Cells, University Medical Centre Groningen, University of Groningen, Groningen 9700 AD, the Netherlands
| | - Ellen Weersing
- European Institute for the Biology of Ageing (ERIBA), Section Ageing Biology and Stem Cells, University Medical Centre Groningen, University of Groningen, Groningen 9700 AD, the Netherlands
| | - Albertina Dethmers-Ausema
- European Institute for the Biology of Ageing (ERIBA), Section Ageing Biology and Stem Cells, University Medical Centre Groningen, University of Groningen, Groningen 9700 AD, the Netherlands
| | - Martha Ritsema
- European Institute for the Biology of Ageing (ERIBA), Section Ageing Biology and Stem Cells, University Medical Centre Groningen, University of Groningen, Groningen 9700 AD, the Netherlands
| | - Marta Vilà González
- European Institute for the Biology of Ageing (ERIBA), Section Ageing Biology and Stem Cells, University Medical Centre Groningen, University of Groningen, Groningen 9700 AD, the Netherlands
| | - Erik Zwart
- European Institute for the Biology of Ageing (ERIBA), Section Ageing Biology and Stem Cells, University Medical Centre Groningen, University of Groningen, Groningen 9700 AD, the Netherlands
| | - Leonid V Bystrykh
- European Institute for the Biology of Ageing (ERIBA), Section Ageing Biology and Stem Cells, University Medical Centre Groningen, University of Groningen, Groningen 9700 AD, the Netherlands
| | - Gerald de Haan
- European Institute for the Biology of Ageing (ERIBA), Section Ageing Biology and Stem Cells, University Medical Centre Groningen, University of Groningen, Groningen 9700 AD, the Netherlands.
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8
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Rossi JG, Bernasconi AR, Alonso CN, Rubio PL, Gallego MS, Carrara CA, Guitter MR, Eberle SE, Cocce M, Zubizarreta PA, Felice MS. Lineage switch in childhood acute leukemia: an unusual event with poor outcome. Am J Hematol 2012; 87:890-7. [PMID: 22685031 DOI: 10.1002/ajh.23266] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 05/03/2012] [Accepted: 05/07/2012] [Indexed: 11/06/2022]
Abstract
Although rarely, switches between lymphoid and myeloid lineages may occur during treatment of acute leukemias (AL). Correct diagnosis relies upon confirmation by immunophenotyping of the lineage conversion and certification that the same cytogenetic/molecular alterations remain despite the phenotypic changes. From a total of 1,482 AL pediatric patients, we report nine cases of lineage conversion (0.6%), seven from lymphoid (four Pro-B, two Pre-B, one Common) to myelo-monocytic, and two from myeloid (bilineal, with myeloid predominance) to Pro-B. Eight patients were infants. Switches were suggested by morphology and confirmed with a median of 15 days (range: 8 days-6 months) from initiation of therapy. Of note, in five cases switches occurred before day 15. Stability of the clonal abnormalities was assessed by cytogenetic, RT-PCR/Ig-TCR rearrangement studies in all patients. Abnormalities in 11q23/MLL gene were detected in seven cases. Treatment schedules were ALL (two pts), Interfant-99 (five pts) and AML (two pts) protocols. Despite changing chemotherapy according to the new lineage, all patients died. Our findings support the association of lineage switches with MLL gene alterations and the involvement of a common lymphoid B-myeloid precursor. New therapies should be designed to address these rare cases. Possible mechanisms implicated are discussed.
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MESH Headings
- Adolescent
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cell Lineage/genetics
- Child
- Child, Preschool
- Chromosomes, Human, Pair 11/genetics
- Cytogenetic Analysis
- Gene Rearrangement, T-Lymphocyte/genetics
- Histocytochemistry
- Histone-Lysine N-Methyltransferase
- Humans
- Immunophenotyping
- Infant
- Infant, Newborn
- Leukemia, Monocytic, Acute/drug therapy
- Leukemia, Monocytic, Acute/genetics
- Leukemia, Monocytic, Acute/mortality
- Leukemia, Monocytic, Acute/pathology
- Myeloid-Lymphoid Leukemia Protein/genetics
- Oncogene Proteins, Fusion/genetics
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Reverse Transcriptase Polymerase Chain Reaction
- Translocation, Genetic
- Treatment Outcome
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Affiliation(s)
- Jorge G Rossi
- Immunology and Rheumatology Department, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Argentina.
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Lineage switching in acute leukemias: a consequence of stem cell plasticity? BONE MARROW RESEARCH 2012; 2012:406796. [PMID: 22852088 PMCID: PMC3407598 DOI: 10.1155/2012/406796] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 05/08/2012] [Indexed: 01/26/2023]
Abstract
Acute leukemias are the most common cancer in childhood and characterized by the uncontrolled production of hematopoietic precursor cells of the lymphoid or myeloid series within the bone marrow. Even when a relatively high efficiency of therapeutic agents has increased the overall survival rates in the last years, factors such as cell lineage switching and the rise of mixed lineages at relapses often change the prognosis of the illness. During lineage switching, conversions from lymphoblastic leukemia to myeloid leukemia, or vice versa, are recorded. The central mechanisms involved in these phenomena remain undefined, but recent studies suggest that lineage commitment of plastic hematopoietic progenitors may be multidirectional and reversible upon specific signals provided by both intrinsic and environmental cues. In this paper, we focus on the current knowledge about cell heterogeneity and the lineage switch resulting from leukemic cells plasticity. A number of hypothetical mechanisms that may inspire changes in cell fate decisions are highlighted. Understanding the plasticity of leukemia initiating cells might be fundamental to unravel the pathogenesis of lineage switch in acute leukemias and will illuminate the importance of a flexible hematopoietic development.
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Park BG, Park CJ, Jang S, Seo EJ, Chi HS, Lee JH. Erythroleukemia relapsing as precursor B-cell lymphoblastic leukemia. Korean J Lab Med 2011; 31:81-5. [PMID: 21474980 PMCID: PMC3116004 DOI: 10.3343/kjlm.2011.31.2.81] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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.
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Affiliation(s)
- Borae G Park
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
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