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Chaber R, Gurgul A, Wróbel G, Tomoń A, Paszek S, Potocka N, Haus O, Lejman M, Łach K, Szmatoła T, Jasielczuk I, Rybka B, Ryczan-Krawczyk R, Stąpor S, Ciebiera K, Arthur CJ, Zawlik I. The distinguishable DNA whole genome methylation profile of 2 cases of pediatric precursor B acute lymphoblastic leukaemia (BCP ALL) with prodromal, preleukemic phase: A case report. Medicine (Baltimore) 2018; 97:e12763. [PMID: 30334962 PMCID: PMC6211912 DOI: 10.1097/md.0000000000012763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE A prolonged, prodromal phase before definitive paediatric precursor B acute lymphoblastic leukaemia (BCP ALL) diagnosis is rarely observed. PATIENTS CONCERNS In the first, the patient presented with an aplastic preleukemic phase, whilst the second presented with a rheumatic-like preliminary phase. DIAGNOSES The case reports of two patients with BCP ALL with a prodromal phase lasting a few weeks are presented. INTERVENTIONS AND OUTCOMES DNA whole genome profile methylation analysis of bone marrow cells obtained at diagnosis revealed a pattern of methylation that was readily distinguishable from both healthy and standard course BCP ALL bone marrow samples. LESSONS The biological implication of this observation remains unclear, with many differentially methylated loci involved in many processes like neurogenesis, cell projection organization and adhesion along with leucocyte activation and apoptosis. The prevalence and clinical significance of these methylation changes is unknown but this data indicates that the epigenetic basis of BCP ALL with a prolonged, prodromal phase requires a more detailed assessment.
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Affiliation(s)
- Radosław Chaber
- Department of Pediatric Hematooncology, Faculty of Medicine, University of Rzeszow, Rzeszow
| | - Artur Gurgul
- National Research Institute of Animal Production, Laboratory of Genomics, Balice
| | - Grażyna Wróbel
- Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Medical University of Wroclaw, Wroclaw
| | - Anna Tomoń
- Department of Pediatric Hematooncology, Faculty of Medicine, University of Rzeszow, Rzeszow
| | - Sylwia Paszek
- Laboratory of Molecular Biology, Centre for Innovative Research in Medical and Natural Sciences, Faculty of Medicine, University of Rzeszow, Rzeszow
| | - Natalia Potocka
- Laboratory of Molecular Biology, Centre for Innovative Research in Medical and Natural Sciences, Faculty of Medicine, University of Rzeszow, Rzeszow
| | - Olga Haus
- Department of Clinical Genetics, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Bydgoszcz, Nicolaus Copernicus University in Torun, Torun
| | - Monika Lejman
- Department of Pediatric, Hematology, Oncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin
| | - Kornelia Łach
- Department of Pediatric Hematooncology, Faculty of Medicine, University of Rzeszow, Rzeszow
| | - Tomasz Szmatoła
- National Research Institute of Animal Production, Laboratory of Genomics, Balice
| | - Igor Jasielczuk
- National Research Institute of Animal Production, Laboratory of Genomics, Balice
| | - Blanka Rybka
- Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Medical University of Wroclaw, Wroclaw
| | - Renata Ryczan-Krawczyk
- Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Medical University of Wroclaw, Wroclaw
| | | | | | | | - Izabela Zawlik
- Laboratory of Molecular Biology, Centre for Innovative Research in Medical and Natural Sciences, Faculty of Medicine, University of Rzeszow, Rzeszow
- Department of Genetics, Institution of Experimental and Clinical Medicine, Faculty of Medicine, University of Rzeszow, Rzeszow, Poland
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Höres T, Wendelin K, Schaefer-Eckart K. Spontaneous remission of acute lymphoblastic leukemia: A case report. Oncol Lett 2018; 15:115-120. [PMID: 29285190 PMCID: PMC5738709 DOI: 10.3892/ol.2017.7288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/23/2017] [Indexed: 12/26/2022] Open
Abstract
Spontaneous remission (SR) in acute lymphoblastic leukemia (ALL) is a rare phenomenon, but the disease course and its underlying processes are of basic and clinical interest. Herein is reported the case of a pregnant, 31-year-old patient who developed ALL, followed by septic shock and SR of ALL. Information is summarized from earlier case reports and incidences of SR in ALL, to identify common patterns. Furthermore, the phenomenon of SR is compared with another disease variant of ALL, termed prodromal or preceding-ALL (pre-ALL). SR and the aleukemic phase in pre-ALL are associated with fever and/or sepsis and have similar kinetics and epidemiology. Therefore, pre-ALL not only closely resembles SR in ALL, but both conditions may represent a single disease entity. Production of pro-inflammatory cytokines and immune cell effects may induce temporary remission of ALL and the suppression of hematopoiesis. In contrast to SR in other types of cancer, all documented cases of SR in ALL were only transient. However, the disease can still be effectively treated with standard ALL therapies following relapse.
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Affiliation(s)
- Timm Höres
- Department of Hematology and Medical Oncology, Paracelsus Medical University, D-90419 Nuremberg, Germany
| | - Knut Wendelin
- Department of Hematology and Medical Oncology, Paracelsus Medical University, D-90419 Nuremberg, Germany
| | - Kerstin Schaefer-Eckart
- Department of Hematology and Medical Oncology, Paracelsus Medical University, D-90419 Nuremberg, Germany
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Liang Y, Ding L, Li X, Wang W, Zhang X. Transient pancytopenia preceding adult acute lymphoblastic leukemia with chromosomal abnormalities including the Philadelphia chromosome: A case report and review of the literature. Oncol Lett 2016; 10:3789-3792. [PMID: 26788209 DOI: 10.3892/ol.2015.3766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 09/09/2015] [Indexed: 11/06/2022] Open
Abstract
A preleukaemic phase, typified by transient pancytopenia, is a rare occurrence that usually affects children and adolescents. The present study reports the case of a 50-year-old woman with transient pancytopenia, which manifested as a fever, cough and severe anemia. Three weeks following treatment of pancytopenia with antibiotics, red blood cell and platelet transfusion, granulocyte colony-stimulating factor and human γ globulin, the condition of the patient was improved. However, 3 weeks following discharge from hospital, the patient was diagnosed with acute lymphoblastic leukemia (ALL) with complex chromosomal abnormalities, including Philadelphia chromosome and P190 breakpoint cluster region-ABL. Complete remission was achieved following one course of combination chemotherapy. In conclusion, adult ALL with pancytopenia as a preceding symptom is rare, difficult to diagnose early and easily misdiagnosed. In addition, the pathogenesis of ALL and the precipitating factors underlying this disease require further investigation.
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Affiliation(s)
- Yun Liang
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Luyin Ding
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Xian Li
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Weiqin Wang
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Xiaohong Zhang
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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Boonchalermvichian C, Xie Y, Brynes RK, Siddiqi IN. Spontaneous, transient regression of B lymphoblastic leukemia in an adult patient: a variant presentation of prodromal/pre-ALL. Leuk Res 2011; 36:e57-9. [PMID: 22129477 DOI: 10.1016/j.leukres.2011.10.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 10/27/2011] [Accepted: 10/31/2011] [Indexed: 11/25/2022]
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Li Q, Chen Z, You Y, Zou P. Transient pancytopenia preceding acute lymphoblastic leukemia with positive Philadelphia chromosome. Leuk Res 2008; 32:1317-20. [PMID: 18291524 DOI: 10.1016/j.leukres.2008.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Revised: 01/04/2008] [Accepted: 01/05/2008] [Indexed: 11/18/2022]
Affiliation(s)
- Qiubai Li
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
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Kikuchi M, Ohsaka A, Chiba Y, Sato M, Muraosa Y, Hoshino H. Bone marrow aplasia with prominent atypical plasmacytic proliferation preceding acute lymphoblastic leukemia. Leuk Lymphoma 1999; 35:213-7. [PMID: 10512180 DOI: 10.3109/10428199909145722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A two-year-old boy presented with pancytopenia. Bone marrow examination revealed an aplastic marrow with prominent immature plasma cell proliferation, which mimicked plasma cell leukemia. Immunohistochemistry, however, revealed a polyclonal population consistent with a reactive process, excluding plasma cell neoplasia. Administration of granulocyte-colony stimulating factor resulted in recovery of normal hematopoiesis with resolution of plasmacytosis. Seven months later, the patient had an elevated white blood cell count and bone marrow findings diagnostic of acute lymphoblastic leukemia. To the best of our knowledge this is the first reported case of bone marrow aplasia with prominent polyclonal plasmacytosis presenting as a prodrome of acute lymphoblastic leukemia in childhood.
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Affiliation(s)
- M Kikuchi
- Department of Pediatrics, Hitachi General Hospital, Japan.
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Sohn SK, Suh JS, Lee J, Lee KB. Pancytopenic prodrome (pre-ALL) of acute lymphoblastic leukemia in adults: possible pathogenesis. Korean J Intern Med 1998; 13:64-7. [PMID: 9538635 PMCID: PMC4531931 DOI: 10.3904/kjim.1998.13.1.64] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We report two cases of adult acute lymphoblastic leukemia presenting with preleukemic phase of pancytopenia with a few abnormal lymphoid cells in bone marrow aspirates. The initial diagnosis of each case was suspicious aplastic anemia and hypoplastic anemia. Both cases progressed to overt acute lymphoblastic leukemia within 1 year. We suggest that initial pancytopenic phase (pre-ALL) may precede the diagnosis of acute lymphoblastic leukemia in adults and differential diagnosis from myelodysplastic syndrome and primary aplastic anemia will be needed. We also suggest that primary bone marrow lymphoma and "primary unknown metastatic lymphoma of bone marrow" may be possible as the pathogenesis in a case like ours.
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Affiliation(s)
- S K Sohn
- Department of Clinical Pathology, Kyungpook National University Hospital, Taegu, Korea
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Keung YK, Cobos E, Morgan D, Tonk V. Development of minimally differentiated acute myeloblastic leukemia with novel isochromosome 18p and antecedent aplastic anemia. CANCER GENETICS AND CYTOGENETICS 1996; 92:1-3. [PMID: 8956860 DOI: 10.1016/s0165-4608(96)00171-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We describe a case of acute myeloblastic leukemia with a novel isochromosome 18, i(18)(p10), preceded by aplastic anemia for six months. The patient is a cotton grower chronically exposed to pesticides. The significance of this chromosomal abnormality is unknown. The possible relationship to the preceding history of aplastic anemia and occupational pesticide exposure is speculated on. The possible mechanism of the association of acute leukemia and aplastic anemia is discussed.
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Affiliation(s)
- Y K Keung
- Division of Oncology/Hematology, Texas Tech University Health Sciences Center, Lubbock 79430, USA
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