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.


Journal Article

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).Retrospective review of clinical and laboratory data.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.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.

Full Text

Duke Authors

Cited Authors

  • Wu, B; Jug, R; Luedke, C; Su, P; Rehder, C; McCall, C; Lagoo, AS; Wang, E

Published Date

  • August 2017

Published In

Volume / Issue

  • 148 / 2

Start / End Page

  • 136 - 147

PubMed ID

  • 28898985

Pubmed Central ID

  • 28898985

Electronic International Standard Serial Number (EISSN)

  • 1943-7722

International Standard Serial Number (ISSN)

  • 0002-9173

Digital Object Identifier (DOI)

  • 10.1093/ajcp/aqx055


  • eng