title: Very early onset of an acute myeloid leukemia in an adult patient with B-cell lymphoblastic leukemia.
abstract: We report on a case of a 30-year-old male with acute B-lymphoblastic leukemia (B-ALL) with immunophenotype CD19(+), CD22(+), CD20(+), CD10(+), with aberrant expression of CD13 and CD117, and IgH gene rearrangements. Three months after treatment with GMALL-2003 and Ida/FLAG protocols bone marrow showed predominance of blasts with myeloid morphology and phenotype MPO(+), CD13(+), CD33(+), CD64(+), CD15(+), CD56(+), EVI-1 gene overexpression and lack of IgH rearrangements. The case is the first report of a very early emergence of myeloid leukemia during the induction treatment for B-ALL in an adult patient. Different pathogenetic mechanisms are discussed - clonal evolution or selection, lineage switch or development of a de novo or therapy-induced leukemia.
authors.affiliation: Laboratory of Cytopathology, Histopathology and Immunology, National Center of Haematology and Transfusiology, Sofia, Bulgaria.
authors.forename: V
authors.initials: V
authors.lastname: Shivarov
authors.forename: A
authors.initials: A
authors.lastname: Stoimenov
authors.forename: I
authors.initials: I
authors.lastname: Galabova
authors.forename: G
authors.initials: G
authors.lastname: Balatzenko
authors.forename: M
authors.initials: M
authors.lastname: Guenova
mesh_terms: D000328:Adult; D017809:Fatal Outcome; D015322:Gene Rearrangement, B-Lymphocyte; D005803:Genes, Immunoglobulin / Q000235:genetics; D006801:Humans; D015448:Leukemia, B-Cell / Q000150:complications* / Q000473:pathology; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000235:genetics / Q000473:pathology; D008297:Male