title: Therapy-related acute lymphoblastic leukemia with t(9;22)(q34;q11.2):a case study and review of the literature.
abstract: Therapy-related acute lymphoblastic leukemia (t-ALL) with t(9;22)(q34;q11.2) is rarely reported as a secondary malignant neoplasm. To our knowledge, only 10 Ph+ t-ALL cases have been reported in the literature. However, 8/10 cases were not reported individually but constituted parts of larger studies reporting cytogenetic abnormalities in secondary leukemia. Snyder et al. first reported Ph+ t-ALL in two patients who had been treated successfully for Ewing sarcoma. We present a novel case of t-ALL with t(9;22) in a patient with primary breast cancer. The interval between diagnosis of breast cancer and the appearance of ALL was 4 years. The patient was treated with partial mastectomy and axillary lymph node dissection followed by six cycles of CMF (cyclophosphamide, methotrexate, 5-fluorouracil) chemotherapy and radiation therapy. Bone metastases were found 3 years after surgery, and she was treated with epirubicin and paclitaxel. This case has the following unique features: BCR/ABL gene rearrangement in t-ALL, and two types of malignant cells (leukemic lymphoblasts and metastatic breast cancer cells) coexisted in the bone marrow.
authors.affiliation: Department of Laboratory Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea.
authors.forename: Sang-Guk
authors.initials: SG
authors.lastname: Lee
authors.forename: Jong Rak
authors.initials: JR
authors.lastname: Choi
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Kim
authors.forename: Tae Sung
authors.initials: TS
authors.lastname: Park
authors.forename: Kyung-A
authors.initials: KA
authors.lastname: Lee
authors.forename: Jaewoo
authors.initials: J
authors.lastname: Song
mesh_terms: D044963:Biopsy, Fine-Needle; D001853:Bone Marrow / Q000473:pathology; D002892:Chromosomes, Human, Pair 22 / Q000235:genetics*; D002899:Chromosomes, Human, Pair 9 / Q000235:genetics*; D005260:Female; D006801:Humans; D007621:Karyotyping; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000235:genetics* / Q000473:pathology; D014178:Translocation, Genetic