title: Molecular heterogeneity in acute leukemia lineage switch.
abstract: Six cases of acute leukemia that underwent lineage switch from acute lymphocytic leukemia to acute myelogenous leukemia are reported. The mean age of the patients was 24 years, time to conversion was 36 months, and survival after conversion was only 3 months. Of the three cases which showed abnormal metaphases at both diagnosis and conversion, two (cases 2, 5) showed related cytogenetic abnormalities, and the third showed (case 3) independent chromosomal changes. Molecular analysis for immunoglobulin heavy chain and T-cell receptor beta chain genes showed that five of the six cases had rearrangement of at least one of these lymphoid associated genes at conversion to acute myelogenous leukemia. The single case (case 3) in which there were no lymphoid gene rearrangements at conversion was also the only case in which independent karyotypic abnormalities at diagnosis and conversion were demonstrated. Our findings suggest that lineage switch can represent either relapse of the original clone with heterogeneity at the molecular level or the emergence of a second new leukemic clone without molecular heterogeneity.
authors.affiliation: Department of Hematology, University of Texas, M.D. Anderson Cancer Center, Houston.
authors.forename: G A
authors.initials: GA
authors.lastname: Gagnon
authors.forename: C C
authors.initials: CC
authors.lastname: Childs
authors.forename: A
authors.initials: A
authors.lastname: LeMaistre
authors.forename: M
authors.initials: M
authors.lastname: Keating
authors.forename: A
authors.initials: A
authors.lastname: Cork
authors.forename: J M
authors.initials: JM
authors.lastname: Trujillo
authors.forename: K
authors.initials: K
authors.lastname: Nellis
authors.forename: E
authors.initials: E
authors.lastname: Freireich
authors.forename: S A
authors.initials: SA
authors.lastname: Stass
mesh_terms: D015703:Antigens, CD / Q000032:analysis; D015214:Antigens, Differentiation, Myelomonocytic / Q000032:analysis; D000951:Antigens, Neoplasm / Q000032:analysis; D000954:Antigens, Surface / Q000032:analysis; D002869:Chromosome Aberrations / Q000473:pathology; D025063:Chromosome Disorders; D015326:Gene Rearrangement, B-Lymphocyte, Heavy Chain; D015333:Gene Rearrangement, beta-Chain T-Cell Antigen Receptor; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000201:enzymology / Q000473:pathology*; D008854:Microscopy, Electron; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000201:enzymology / Q000473:pathology*; D013997:Time Factors
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D000951:Antigens, Neoplasm; D000954:Antigens, Surface