title: Acute nonlymphoblastic leukemia in children treated for acute lymphoblastic leukemia with an intensive regimen including teniposide.
abstract: Some cases of conversion from acute lymphoblastic leukemia (ALL) to acute nonlymphoblastic leukemia (ANLL) at relapse have been reported recently. We report three cases initially diagnosed as having ALL and showing morphological, cytochemical, and immunophenotypic features of ANLL at relapse (lineage switch). Conversion was observed among 14 patients who developed bone marrow relapse while undergoing intensive treatment with our ALL protocol, which includes teniposide, and that had been administered to 62 patients. The three cases converted at first relapse, with a mean time of 20 months (13-29 months). Clinical and immunologic characteristics of T-cell leukemia were present in one patient. Changes documented in cytogenetic studies are discussed. The underlying mechanisms for the lineage switch remain unclear as does its relation with mixed lineage leukemias, but we believe that drugs employed in our therapy protocol could have had an influence on this conversion.
authors.affiliation: Pediatric Oncology Unit, Hospital Infantil La Fe, Valencia, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Verdeguer
authors.forename: J G
authors.initials: JG
authors.lastname: Ruiz
authors.forename: J
authors.initials: J
authors.lastname: Ferris
authors.forename: C
authors.initials: C
authors.lastname: Esquembre
authors.forename: M J
authors.initials: MJ
authors.lastname: Tasso
authors.forename: J M
authors.initials: JM
authors.lastname: Fernandez
authors.forename: F
authors.initials: F
authors.lastname: Prieto
authors.forename: V
authors.initials: V
authors.lastname: Castel
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D016609:Neoplasms, Second Primary / Q000139:chemically induced*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy; D013713:Teniposide / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D013713:Teniposide