Secondary pure erythroid leukaemia in relapsed acute lymphoblastic leukaemia: lineage switch or chemotherapy effect?
Pure erythroid leukaemia is a rare subtype of acute myeloid leukaemia (AML) and its occurrence at acute lymphoblastic leukaemia (ALL) relapse has not been reported earlier. A 39-year-old man received chemotherapy for Philadelphia-negative B cell ALL. Subsequently, he developed pure erythroid leukaemia with >80% immature erythroid precursors in bone marrow showing block positivity on periodic acid-Schiff stain, expressing CD71, CD34 but lacking CD235a. The interval between exposure to multidrug chemotherapy including cyclophosphamide and AML diagnosis was 2 years and 9 months. No cytogenetic abnormality was detected at the time of relapse. The patient died 2 weeks after starting AML chemotherapy. The relatively narrow time interval (usually 5-10 years) between chemotherapy and AML development and normal karyotype at relapse raises a possibility of lineage switch besides therapy-related AML as the likely pathogenesis. Further exploration of such cases may unravel the pathways responsible for lineage assignment in pluripotent stem cells.
Laboratory Oncology Unit, Dr B.R.A. Institute Rotary Cancer Hospital (IRCH), All India Institute of Medical Sciences (AIIMS), Delhi, India.
Sanjeev Kumar
SK
Gupta
Laboratory Oncology Unit, Dr B.R.A. Institute Rotary Cancer Hospital (IRCH), All India Institute of Medical Sciences (AIIMS), Delhi, India.
Rajive
R
Kumar
Laboratory Oncology Unit, Dr B.R.A. Institute Rotary Cancer Hospital (IRCH), All India Institute of Medical Sciences (AIIMS), Delhi, India.
Taher
T
Chharchhodawala
Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), Delhi, India.
Lalit
L
Kumar
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001803:Blood Transfusion / Q000379:methods; D001853:Bone Marrow / Q000473:pathology; D019070:Cell Lineage / Q000502:physiology*; D002471:Cell Transformation, Neoplastic / Q000473:pathology; D018450:Disease Progression; D017809:Fatal Outcome; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology*; D009367:Neoplasm Staging; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*; D012074:Remission Induction