title: THERAPY-RELATED T/MYELOID MIXED PHENOTYPE ACUTE LEUKEMIA IN A PATIENT TREATED WITH CHEMOTHERAPY FOR CUTANEOUS DIFFUSE LARGE B CELL LYMPHOMA.
abstract: Mixed-phenotype acute leukemia is a rare form of leukemia that is associated with a poor prognosis. Most cases of mixed-phenotype acute leukemia are de novo. However, therapy-related mixed-phenotype acute leukemia can occur, and are often associated with exposure to topoisomerase-II inhibitors and alkylating agents. There are no known treatment guidelines for therapy-related mixed-phenotype acute leukemia. We present a patient with T/myeloid mixed-phenotype acute leukemia secondary to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone R-CHOP chemotherapy for primary cutaneous diffuse large B-cell lymphoma. The patient's leukemic cells express CD34, an immaturity marker, CD3, a T-cell marker, and myeloperoxidase, a myeloid marker, and her history of chemotherapy for previous lymphoma supports the diagnosis of therapy-related T/myeloid mixed phenotype acute leukemia. Clinicians should be aware that this entity could be associated with R-CHOP chemotherapy. Given the complexity in diagnosis, and lack of treatment guidelines, a further understanding of the pathological and genetic principles of therapy-related mixed-phenotype acute leukemia will assist in future efforts to treat and categorize these patients. Mixed phenotype acute leukemia is a rare entity that accounts for two to five percent of all acute leukemias. Therapy- related mixed phenotype acute leukemia is an exceedingly rare hematological neoplasm that accounts for less than one percent of acute leukemias. We describe a case of therapy-related T/myeloid mixed phenotype acute leukemia following rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone R-CHOP chemotherapy for primary cutaneous diffuse large B-cell lymphoma DLBCL. The patient is a 63-year-old female who presented with several cutaneous nodules diagnosed as primary cutaneous DLBCL. The patient received R-CHOP chemotherapy and achieved remission. She remained in remission for four years until she presented with dyspnea, night sweats, weakness, and diffuse lymphadenopathy. Her presentation was initially concerning for recurrent lymphoma; however, a bone marrow biopsy and aspirate and a lymph node biopsy revealed a distinct blast population consistent with T/myeloid mixed phenotype acute leukemia T/M-MPAL. Given the patient's history of previous chemotherapy exposure, our patient represents a case of therapy-related T/myeloid mixed phenotype acute leukemia t-MPAL.
authors.affiliation: Dr. Roberts is associated with the Department of Pathology and Laboratory Medicine, Tulane University, New Orleans, LA .
authors.forename: Evans
authors.initials: E
authors.lastname: Roberts
authors.affiliation: Dr. Oncale is associated with the Department of Medicine, Tulane University, New Orleans, LA.
authors.forename: Melody
authors.initials: M
authors.lastname: Oncale
authors.affiliation: Dr. Safah is associated with the Department of Oncology and Medical Hematology, Tulane University, New Orleans, LA.
authors.forename: Hana
authors.initials: H
authors.lastname: Safah
authors.affiliation: Dr. Schmieg is associated with the Department of Pathology and Laboratory Medicine, Tulane University, New Orleans, LA .
authors.forename: John
authors.initials: J
authors.lastname: Schmieg
mesh_terms: D000208:Acute Disease; D000971:Antineoplastic Combined Chemotherapy Protocols; D005260:Female; D006801:Humans; D007951:Leukemia, Myeloid / Q000139:chemically induced*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy*; D008875:Middle Aged; D010641:Phenotype; D011241:Prednisone; D000069283:Rituximab / Q000009:adverse effects*
chemical_list: D000069283:Rituximab; D011241:Prednisone