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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.

Publication ,  Journal Article
Wu, B; Jug, R; Luedke, C; Su, P; Rehder, C; McCall, C; Lagoo, AS; Wang, E
Published in: Am J Clin Pathol
August 1, 2017

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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Published In

Am J Clin Pathol

DOI

EISSN

1943-7722

Publication Date

August 1, 2017

Volume

148

Issue

2

Start / End Page

136 / 147

Location

England

Related Subject Headings

  • Young Adult
  • Pathology
  • Neoplasms, Second Primary
  • Myelodysplastic Syndromes
  • Male
  • Leukemia, Myeloid, Acute
  • Leukemia, B-Cell
  • Humans
  • Genomic Instability
  • Chromosome Aberrations
 

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Wu, B., Jug, R., Luedke, C., Su, P., Rehder, C., McCall, C., … Wang, E. (2017). 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, 148(2), 136–147. https://doi.org/10.1093/ajcp/aqx055
Wu, Bin, Rachel Jug, Catherine Luedke, Pu Su, Catherine Rehder, Chad McCall, Anand S. Lagoo, and Endi Wang. “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 148, no. 2 (August 1, 2017): 136–47. https://doi.org/10.1093/ajcp/aqx055.
Journal cover image

Published In

Am J Clin Pathol

DOI

EISSN

1943-7722

Publication Date

August 1, 2017

Volume

148

Issue

2

Start / End Page

136 / 147

Location

England

Related Subject Headings

  • Young Adult
  • Pathology
  • Neoplasms, Second Primary
  • Myelodysplastic Syndromes
  • Male
  • Leukemia, Myeloid, Acute
  • Leukemia, B-Cell
  • Humans
  • Genomic Instability
  • Chromosome Aberrations