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B-cell acute lymphoblastic leukemia with t(4;11)(q21;q23) in a young woman: evolution into mixed phenotype acute leukemia with additional chromosomal aberrations in the course of therapy.

Carulli G, Marini A, Ferreri MI, AzzarĂ  A, Ottaviano V, Lari T, Rocco M, Giuntini S, Petrini M - Hematol Rep (2012)

Bottom Line: Karyotype showed the co-existence of three cell lines, with persistence of t(4;11)(q21;q23) and appearance of +8,+12,+13 and two der(4).The patient died because of disseminated intravascular coagulation.This finding suggests a blast cell derivation from a common lymphoid/monocytic precursor leading to a final bilineal acute leukemia.

View Article: PubMed Central - PubMed

Affiliation: Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa;

ABSTRACT
About 5% of adult B-cell acute lymphoblastic leukemias (B-ALL) are characterized by t(4;11)(q21;q23), which confers peculiar features to this B-ALL subtype, including a very immature immunophenotype and poor prognosis. We describe the case of a 21-year-old female who presented with B-ALL carrying the t(4;11)(q21;q23) and blasts positive for CD19, TdT, CD79a, CD38, HLA-DR. Before completing the Hyper-CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone) therapy regimen, the B-cell leukemic clone still was detected, but an additional leukemic clone appeared, with morphology and immunophenotype (CD13, CD33, CD64, CD38, CD56, CD15, CD4(dim)) compatible with derivation from the myeloid/monocytic lineage. Karyotype showed the co-existence of three cell lines, with persistence of t(4;11)(q21;q23) and appearance of +8,+12,+13 and two der(4). The patient died because of disseminated intravascular coagulation. Our report describes a rare, possible evolution of such a subtype of B-ALL, with transformation into mixed phenotype acute leukemia in the course of therapy. This finding suggests a blast cell derivation from a common lymphoid/monocytic precursor leading to a final bilineal acute leukemia.

No MeSH data available.


Related in: MedlinePlus

Fluorescent hybridization analysis performed on metaphases using whole chromosome painting n. 4 and n.11 probes. Two derivative chromosomes 4 were found.
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Figure 5: Fluorescent hybridization analysis performed on metaphases using whole chromosome painting n. 4 and n.11 probes. Two derivative chromosomes 4 were found.

Mentions: A new evaluation of karyotype confirmed the presence of the sole abnormality t(4;11) (q21;q23) in 10% of metaphases, and showed the appearance of two additional cell lines: one with 50 chromosomes, t(4;11)(q21;q23), trisomy of chromosomes number 8, 12 and 13, and a not well defined supernumerary marker (Figure 4A); the other one with 50 chromosomes, t(4;11)(q21;q23), trisomy of chromosomes number 8, 12 and 13, and a derivative of chromosome 4 [der(4)] (Figure 4B). This latter anomaly was confirmed by FISH, which was performed on metaphases using whole chromosome painting n. 4 and n. 11 probes (Cytocell Inc. UK) and detected two der(4) (Figure 5). It was not possible to perform other studies, with the exception of a new PCR for IgH rearrangement, which showed persistence of a clonal pattern. The patient died because of disseminated intravascular coagulation.


B-cell acute lymphoblastic leukemia with t(4;11)(q21;q23) in a young woman: evolution into mixed phenotype acute leukemia with additional chromosomal aberrations in the course of therapy.

Carulli G, Marini A, Ferreri MI, AzzarĂ  A, Ottaviano V, Lari T, Rocco M, Giuntini S, Petrini M - Hematol Rep (2012)

Fluorescent hybridization analysis performed on metaphases using whole chromosome painting n. 4 and n.11 probes. Two derivative chromosomes 4 were found.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3475937&req=5

Figure 5: Fluorescent hybridization analysis performed on metaphases using whole chromosome painting n. 4 and n.11 probes. Two derivative chromosomes 4 were found.
Mentions: A new evaluation of karyotype confirmed the presence of the sole abnormality t(4;11) (q21;q23) in 10% of metaphases, and showed the appearance of two additional cell lines: one with 50 chromosomes, t(4;11)(q21;q23), trisomy of chromosomes number 8, 12 and 13, and a not well defined supernumerary marker (Figure 4A); the other one with 50 chromosomes, t(4;11)(q21;q23), trisomy of chromosomes number 8, 12 and 13, and a derivative of chromosome 4 [der(4)] (Figure 4B). This latter anomaly was confirmed by FISH, which was performed on metaphases using whole chromosome painting n. 4 and n. 11 probes (Cytocell Inc. UK) and detected two der(4) (Figure 5). It was not possible to perform other studies, with the exception of a new PCR for IgH rearrangement, which showed persistence of a clonal pattern. The patient died because of disseminated intravascular coagulation.

Bottom Line: Karyotype showed the co-existence of three cell lines, with persistence of t(4;11)(q21;q23) and appearance of +8,+12,+13 and two der(4).The patient died because of disseminated intravascular coagulation.This finding suggests a blast cell derivation from a common lymphoid/monocytic precursor leading to a final bilineal acute leukemia.

View Article: PubMed Central - PubMed

Affiliation: Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa;

ABSTRACT
About 5% of adult B-cell acute lymphoblastic leukemias (B-ALL) are characterized by t(4;11)(q21;q23), which confers peculiar features to this B-ALL subtype, including a very immature immunophenotype and poor prognosis. We describe the case of a 21-year-old female who presented with B-ALL carrying the t(4;11)(q21;q23) and blasts positive for CD19, TdT, CD79a, CD38, HLA-DR. Before completing the Hyper-CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone) therapy regimen, the B-cell leukemic clone still was detected, but an additional leukemic clone appeared, with morphology and immunophenotype (CD13, CD33, CD64, CD38, CD56, CD15, CD4(dim)) compatible with derivation from the myeloid/monocytic lineage. Karyotype showed the co-existence of three cell lines, with persistence of t(4;11)(q21;q23) and appearance of +8,+12,+13 and two der(4). The patient died because of disseminated intravascular coagulation. Our report describes a rare, possible evolution of such a subtype of B-ALL, with transformation into mixed phenotype acute leukemia in the course of therapy. This finding suggests a blast cell derivation from a common lymphoid/monocytic precursor leading to a final bilineal acute leukemia.

No MeSH data available.


Related in: MedlinePlus