title: CD15(+) acute lymphoblastic leukemia and subsequent monoblastic leukemia: persistence of t(4;11) abnormality and B-cell gene rearrangement.
abstract: The abnormality in the translocation of chromosomes 4 and 11 (t[4;11]) has been characteristically associated with calla-negative CD15(+) acute lymphoblastic leukemia (ALL) of early pre-B-cell origin. Transformation of a lymphoblastoid to a monoblastoid morphologic structure has rarely been described at relapse in these cases; however, these cases have lacked flow cytometric immunophenotyping (FCI) and genotypic studies (GS) to define the immunophenotype of and the presence of a B-cell gene rearrangement in the monoblastoid component. We report a case of CD15(+), CD10(-) ALL of early pre-B-cell origin defined by morphologic testing and FCI with the t(4;11) abnormality. At relapse, the morphologic testing, enzyme cytochemistry, and FCI data were characteristic of monoblastic leukemia. The t(4;11) abnormality persisted with associated additional chromosomal abnormalities, and the monoblasts contained a B-cell gene rearrangement by GS. These findings support the concept that both processes arose from a multipotential progenitor cell.
authors.affiliation: Division of Hematopathology, Department of Pathology, St Louis University Health Sciences Center, St Louis University School of Medicine, St Louis, MO, USA. cdunphy@unch.unc.edu
authors.forename: C H
authors.initials: CH
authors.lastname: Dunphy
authors.forename: L J
authors.initials: LJ
authors.lastname: Gardner
authors.forename: H L
authors.initials: HL
authors.lastname: Evans
authors.forename: N
authors.initials: N
authors.lastname: Javadi
mesh_terms: D015703:Antigens, CD / Q000097:blood; D001402:B-Lymphocytes / Q000276:immunology; D001752:Blast Crisis / Q000235:genetics; D016026:Bone Marrow Transplantation; D002874:Chromosome Mapping; D002880:Chromosomes, Human, Pair 11; D002894:Chromosomes, Human, Pair 4; D005260:Female; D005434:Flow Cytometry; D015322:Gene Rearrangement, B-Lymphocyte; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics; D016130:Immunophenotyping; D007948:Leukemia, Monocytic, Acute / Q000097:blood / Q000235:genetics* / Q000276:immunology; D016256:Lewis X Antigen / Q000097:blood*; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000097:blood / Q000235:genetics* / Q000276:immunology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000235:genetics* / Q000276:immunology* / Q000473:pathology / Q000628:therapy; D014178:Translocation, Genetic
chemical_list: D015703:Antigens, CD; D007143:Immunoglobulin Heavy Chains; D016256:Lewis X Antigen