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A Pediatric Case of Treatment-related Myelodysplastic Syndrome While on Therapy for Pre-B Acute Lymphoblastic Leukemia. J Pediatr Hematol Oncol 2023; 45:e518-e521. [PMID: 36706304 DOI: 10.1097/mph.0000000000002613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 12/01/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Treatment-related myelodysplastic syndrome (t-MDS) is a rare late effect of cancer therapy. After alkylating agents, this typically occurs years after completion of therapy. Treatment of t-MDS in pediatrics is an allogeneic stem cell transplant, however, the prognosis remains poor. OBSERVATIONS This case demonstrates t-MDS developing in a patient receiving treatment for pre-B acute lymphoblastic leukemia. This patient was treated with a combination of hematopoietic stem cell transplant and hypomethylating agents. CONCLUSIONS These agents should be considered for use in patients with t-MDS, before transplant to limit additional chemotherapy and as maintenance therapy post-transplant to reduce the risk of relapse.
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Kurzer JH, Weinberg OK. To B- or not to B-: A review of lineage switched acute leukemia. Int J Lab Hematol 2022; 44 Suppl 1:64-70. [PMID: 35770493 DOI: 10.1111/ijlh.13923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022]
Abstract
Acute leukemia is a heterogeneous disorder of hematologic malignancies composed primarily of hematopoietic precursors that have acquired unregulated self-renewal and proliferation. Hematology classification systems typically divide these neoplasms into lymphoid (B- or T-) and myeloid-lineage subtypes, with therapy dependent upon this distinction. Infrequently, certain acute leukemias may undergo a complete lineage switch at relapse, subsequently complicating the diagnosis and treatment of these recurrent diseases. Transformation from B-lineage to myeloid lineage is the most common switch observed, and is frequently associated with a balanced 11q23 translocation, involving KMT2A. The mechanisms involved in the lineage-switch are unclear, but modern therapies targeting the B-cell-specific marker, CD19, have proven to promote this conversion as one means of treatment escape. Broadly speaking, therapy-mediated selection of alternate lineage-committed subclones derived from the same initial pluripotent progenitors, clonal evolution and reprogramming of lineage-committed blasts, and de novo clonally unrelated leukemias may account for the clinical impression of lineage switched acute leukemia during treatment. This review will explore the phenomenon and potential mechanisms of lineage transformation during the treatment of acute leukemia.
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Affiliation(s)
- Jason H Kurzer
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Olga K Weinberg
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA
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Yuan X, Yu U, Chen S, Xu H, Yi M, Jiang X, Song J, Chen X, Chen S, Lin Z, Li C, Wen F, Liu S. Case Report: Myeloid Sarcoma Development During Treatment for B Cell Lymphoblastic Lymphoma in a Boy with KRAS/NRAS Gene Mutations. Onco Targets Ther 2021; 14:347-353. [PMID: 33469311 PMCID: PMC7812042 DOI: 10.2147/ott.s276912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/29/2020] [Indexed: 12/11/2022] Open
Abstract
Here, we report a rare case of a 12-year-old boy who was initially diagnosed with B cell lymphoblastic lymphoma (BLBL) and developed myeloid sarcoma (MS) eight months after chemotherapy. Next-generation sequencing (NGS) showed mutations of KRAS and NRAS genes in both the bone marrow and lymph node. He presented an abnormal karyotype of 46, XY, -9, der (16) t (9; 16) (q13; q12), +mar. He received chemotherapy according to the South China Children's Leukemia Group 2016 protocol. Complete remission was achieved by the 15th day post-treatment. Eight months later and immediately prior to the start of maintenance therapy, the patient developed fever, skin nodules in both upper arms, and enlargement of bilateral testes. Pathological analysis of skin and testicular biopsies suggested the diagnosis of myeloid sarcoma (MS). Again, NGS examination showed mutations of KRAS and NRAS genes. The patient underwent haploidentical hematopoietic stem cell transplantation but unfortunately did not survive. The interval of eight-month interval between the initial disease onset and MS brings into question whether MS developed as part of the initial onset of disease or as a secondary tumor in association with chemotherapy. Thus, understanding the pathogenesis of MS involving abnormalities of lymphoid progenitors may assist in the prediction of prognosis and development of novel target therapies.
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Affiliation(s)
- Xiuli Yuan
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, People's Republic of China
| | - Uet Yu
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, People's Republic of China
| | - Senmin Chen
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, People's Republic of China
| | - Huanli Xu
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, People's Republic of China
| | - Meng Yi
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, People's Republic of China
| | - Xianping Jiang
- Department of Pathology, Shenzhen Children's Hospital, Shenzhen, People's Republic of China
| | - Jianming Song
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, People's Republic of China
| | - Xiaowen Chen
- Institute for Medical Research, Shenzhen Children's Hospital, Shenzhen, People's Republic of China
| | - Shiyang Chen
- Institute for Medical Research, Shenzhen Children's Hospital, Shenzhen, People's Republic of China
| | - Zhenhu Lin
- Institute for Medical Research, Shenzhen Children's Hospital, Shenzhen, People's Republic of China
| | - Changgang Li
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, People's Republic of China
| | - Feiqiu Wen
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, People's Republic of China
| | - Sixi Liu
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, People's Republic of China
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Fournier E, Inchiappa L, Delattre C, Pignon JM, Danicourt F, Bemba M, Roche-Lestienne C, Daudignon A, Decool G, Roumier C, Dumezy F, Fournier L, Grardel N, Preudhomme C, Duployez N. Increased risk of adverse acute myeloid leukemia after anti-CD19-targeted immunotherapies in KMT2A-rearranged acute lymphoblastic leukemia: a case report and review of the literature. Leuk Lymphoma 2019; 60:1827-1830. [DOI: 10.1080/10428194.2018.1562185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Elise Fournier
- Laboratory of Hematology, CH Dunkerque, Dunkerque, France
- Laboratory of Hematology, CHU Lille, Lille, France
| | | | | | | | | | - Maxime Bemba
- Hematology Department, CH Dunkerque, Dunkerque, France
| | - Catherine Roche-Lestienne
- Department of Medical Genetics, CHU Lille, Lille, France
- INSERM UMR-S 1172, University of Lille, Lille, France
| | | | - Gauthier Decool
- Laboratory of Hematology, CHU Lille, Lille, France
- INSERM UMR-S 1172, University of Lille, Lille, France
| | - Christophe Roumier
- Laboratory of Hematology, CHU Lille, Lille, France
- INSERM UMR-S 1172, University of Lille, Lille, France
| | - Florent Dumezy
- Laboratory of Hematology, CHU Lille, Lille, France
- INSERM UMR-S 1172, University of Lille, Lille, France
| | - Loïc Fournier
- Laboratory of Hematology, CH Dunkerque, Dunkerque, France
| | - Nathalie Grardel
- Laboratory of Hematology, CHU Lille, Lille, France
- INSERM UMR-S 1172, University of Lille, Lille, France
| | - Claude Preudhomme
- Laboratory of Hematology, CHU Lille, Lille, France
- INSERM UMR-S 1172, University of Lille, Lille, France
| | - Nicolas Duployez
- Laboratory of Hematology, CHU Lille, Lille, France
- INSERM UMR-S 1172, University of Lille, Lille, France
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