Korean J Lab Med.  2011 Apr;31(2):81-85. 10.3343/kjlm.2011.31.2.81.

Erythroleukemia Relapsing as Precursor B-cell Lymphoblastic Leukemia

Affiliations
  • 1Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea. cjpark@amc.seoul.kr
  • 2Department of Internal Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.

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.

Keyword

Erythroleukemia; Lineage switch; Precursor B cell lymphoblastic leukemia

MeSH Terms

Acute Disease
Antimetabolites, Antineoplastic/therapeutic use
Bone Marrow Cells/pathology
Cell Lineage
Cell Transformation, Neoplastic
Chromosome Deletion
Chromosomes, Human, Pair 5
Chromosomes, Human, Pair 7
Cytarabine/therapeutic use
Drug Therapy, Combination
Humans
Immunophenotyping
Karyotyping
Leukemia, Erythroblastic, Acute/*diagnosis/drug therapy
Male
Middle Aged
Monosomy
Naphthacenes/therapeutic use
Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/*diagnosis/pathology
Recurrence

Figure

  • Fig. 1 Findings of the bone marrow aspirate analysis (Wright stain,×1,000). (A) Erythroleukemia (AML-M6a) at initial diagnosis showed medium-sized myeloblasts with a moderate amount of cytoplasm without vacuoles, although a few blasts contained cytoplasmic vacuoles. (B) Precursor B cell ALL at relapse showed lymphoblasts that contained cytoplasmic vacuoles.


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