Korean J Hematol.  2006 Mar;41(1):46-50. 10.5045/kjh.2006.41.1.46.

A Case of Acute Lymphoblastic Leukemia with Maturation

• Kim JH
• Lee WI
• Park SY
• Yoon HJ
• Kang SY
• Suh JT

• KMID: 2252327
• DOI: http://doi.org/10.5045/kjh.2006.41.1.46

Abstract

Acute lymphoblastic leukemia with maturation (ALLm) has different disease characteristics that does typical ALL. ALLm is characterized by an increased number of mature appearing leukemic cells (>20% of ANCs in the BM) having differentiation beyond the prolymphocyte stage according to light microscopic (LM) examination. It also has a worse prognosis than typical ALL. We have recently experienced a case of ALLm and we report on this case along with a literature review. A 36 year old patient showed lymphoblasts and mature appearing leukemic cells that were counted up to 15.8% and 23.0%, respectively, of the WBCs on bone marrow examination. Despite their mature appearance, these cells showed positivity for Tdt, CD10, CD19 and HLA-DR on the immunophenotypic study. Differentiating the mature-appearing leukemic cells from the hematogones or mature lymphocytes is difficult, and only through immunophenotypic examination is it possible to discriminate ALLm from typical ALL. We suggest performing a leukemic marker study that includes CD38 to effectively differentiate mature appearing leukemic cells from hematogones, especially for the follow up of leukemia with mature appearing cells.

Keyword

ALLm; Tdt; CD10; CD19; CD38; HLA-DR

MeSH Terms

Adult
Bone Marrow Examination
Follow-Up Studies
HLA-DR Antigens
Humans
Leukemia
Lymphocytes
Precursor Cell Lymphoblastic Leukemia-Lymphoma*
Prognosis
HLA-DR Antigens

Figure

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  Fig. 1 Bone marrow aspiration & biopsy section smear. Positive finding displaying dot or coarse granular pattern (Periodic acid-Schiff stain, ×1,000).

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  Fig. 2 Bone marrow aspirate smears at time of first relapse demonstrate numerous mature appearing leukemic cells (Wright stain, ×1,000).

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