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Martins F, Kruszewski M, Scarpelli I, Schoumans J, Spertini O, Lübbert M, Blum S. Characterization of myelodysplastic syndromes progressing to acute lymphoblastic leukemia. Ann Hematol 2020; 100:63-78. [PMID: 32556451 DOI: 10.1007/s00277-020-04114-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/01/2020] [Indexed: 12/17/2022]
Abstract
Myelodysplastic syndromes (MDS) are a heterogeneous group of diseases, with a variable probability of transformation into acute leukemia, which is, in the vast majority of cases, of myeloid lineage. Nevertheless, rare cases of acute lymphoblastic leukemia in patients with previously diagnosed MDS have been reported. We describe a series of 3 cases of MDS/CMML marked with evolution to acute lymphoblastic leukemia (ALL) and provide a comprehensive review of the 49 cases documented in the literature so far. These sporadic events have only been published as single-case reports or small series to date. Such atypical cases emphasize the possibility of major phenotypic switches arising at the leukemic stem cell (LSC) and/or early progenitor levels, as a consequence of epigenetic and genomic events driving these changes in the bone marrow niche.
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Affiliation(s)
- Filipe Martins
- Centre Hospitalier Universitaire Vaudois (CHUV), Hematology Service and Central laboratory, Oncology department, Rue du Bugnon 46, Lausanne, CH-1011, Switzerland. .,Service and Central Laboratory of Hematology, Department of Oncology and Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, Lausanne, CH-1011, Switzerland. .,School of Life Sciences, Laboratory of Virology and Genetics, Swiss Federal Institute of Technology Lausanne (EPFL), Station 19, CH-1015, Lausanne, Switzerland.
| | - Michael Kruszewski
- Internal Medicine 1, Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, University Hospital Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Ilaria Scarpelli
- Oncogenomic Laboratory, Hematology Service, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, Lausanne, CH-1011, Switzerland
| | - Jacqueline Schoumans
- Oncogenomic Laboratory, Hematology Service, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, Lausanne, CH-1011, Switzerland
| | - Olivier Spertini
- Service and Central Laboratory of Hematology, Department of Oncology and Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, Lausanne, CH-1011, Switzerland.,Oncogenomic Laboratory, Hematology Service, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, Lausanne, CH-1011, Switzerland
| | - Michael Lübbert
- Internal Medicine 1, Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, University Hospital Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Sabine Blum
- Service and Central Laboratory of Hematology, Department of Oncology and Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, Lausanne, CH-1011, Switzerland.
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Léglise MC, Rivière D, Brière J. Acute Leukemia with a Translocation T(4;11)(q21;q23): a Distinct Clinicopathological Entity: Report of a Case with Cytogenetic Clonal Evolution and Review of 146 Cases of the Literature. Leuk Lymphoma 2009; 2:353-68. [DOI: 10.3109/10428199009069288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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3
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Announcements. Histopathology 2007. [DOI: 10.1111/j.1365-2559.1986.tb02603.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sato N, Nakazato T, Kizaki M, Ikeda Y, Okamoto S. Transformation of Myelodysplastic Syndrome to Acute Lymphoblastic Leukemia: A Case Report and Review of the Literature. Int J Hematol 2004; 79:147-51. [PMID: 15005342 DOI: 10.1532/ijh97.03137] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Myelodysplastic syndrome (MDS) often transforms into acute leukemia, usually of a myeloid phenotype. However, the transformation of MDS into acute lymphoblastic leukemia (ALL) is extremely rare. We present a case of refractory anemia with excess of blasts (RAEB) that transformed into ALL. MDS (RAEB) was diagnosed in a 68-year-old Japanese woman in August 2001. Two months later, MDS progressed to erythroleukemia (French-American-British [FAB]classification, acute myeloid leukemia [AML]-M6), and in December, 2001, she was treated with combined chemotherapy containing aclarubicin, cytarabine, and granulocyte colony-stimulating factor, which improved her clinical symptoms. However, 1 month after the chemotherapy, she developed ALL. The blasts at that time had a markedly basophilic cytoplasm with multiple cytoplasmic vacuoles, and their morphology mimicked that of ALL-L3. The blasts also expressed CD13, a myeloid marker, in addition to lymphoid markers. Southern-blot analysis revealed rearrangement of the immunoglobulin heavy chain, but no additional chromosomal abnormality characteristic of ALL-L3 was detected. The patient was treated with chemotherapy, but she developed tumor lysis syndrome and died of multiple organ failure. Although the precise mechanism of lymphoid transformation is not yet fully understood, this case clinically supports the nature of MDS as a pluripotent hematopoietic stem cell disorder.
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Affiliation(s)
- Norihide Sato
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
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Pajor L, Matolcsy A, Vass JA, Méhes G, Marton E, Szabó F, Iványi JL. Phenotypic and genotypic analyses of blastic cell population suggest that pure B-lymphoblastic leukemia may arise from myelodysplastic syndrome. Leuk Res 1998; 22:13-7. [PMID: 9585074 DOI: 10.1016/s0145-2126(97)00131-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The case history of a 70-year-old man with myelodysplastic syndrome terminated into acute leukemia in 22 months is presented. The leukemic cells exhibited multifocal acid phosphatase positivity and expressed TdT, CD45, CD34 and HLA-DR but not myeloid, monocytic or megakaryocytic differentiation antigenes. The genotypic analysis revealed clonal immunoglobulin heavy chain gene rearrangement. These phenotypic and genotypic analyses of the blastic cell population suggest that myelodysplastic syndrome may transform to pure acute lymphoblastic leukemia of B-cell origin.
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Affiliation(s)
- L Pajor
- Department of Pathology, University Medical School of Pécs, Hungary.
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Lima CS, de Souza CA, Cardinalli IA, Lorand-Metze I. Lymphoblastic transformation of myelodysplastic syndrome. SAO PAULO MED J 1997; 115:1508-12. [PMID: 9595816 DOI: 10.1590/s1516-31801997000400009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Mielodysplastic syndromes (MDS) are clonal disorders of the hemopoietic stem cell. About one third of the cases terminate in an acute leukemia, usually acute myeloblastic leukemia. However, few cases of transformation into acute lymphoblastic leukemia (ALL) have been described. We present a case of refractory anemia that transformed into ALL two months after diagnosis and was successfully treated with conventional chemotherapy. Two years later a hyperfibrotic form of MDS was detected in the patient, that soon after terminated in acute megakaryoblastic leukemia. The course of MDS in the present case provides evidence that MDS can involve a pluripotent stem cell, presenting clonal evolution, documented by successive changes in its clinical and hematological features.
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Affiliation(s)
- C S Lima
- Department of Internal Medicine, Faculty of Medicine, State University of Campinas, Brazil
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Jiménez-Balderas FJ, Morales-Polanco MR, Gutierrez L. Acute sideroblastic anemia in active systemic lupus erythematosus. Lupus 1994; 3:157-9. [PMID: 7951300 DOI: 10.1177/096120339400300305] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This work describes the development of sideroblastic anemia (SA) during the clinical activity of systemic lupus erythematosus (SLE) in two patients. The cases refer to two women with SLE who developed SA during a relapse of the illness. Both patients fulfilled at least four criteria of the American Association of Rheumatology for SLE. In one patient, the treatment with prednisone was followed by the resolution of the SLE activity and the disappearance of the SA. Several years later there was no evidence of ringed sideroblasts or malignancy in the bone marrow. In the other patient, the clinical activity of the SLE and SA developed during the beginning of a septicemic event which finally led to her death. Our clinical cases allow us to show that the transitory development of SA can occur during a period of clinical activity of SLE and that its association, although infrequent, is due to a common physiopathogenic mechanism.
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Affiliation(s)
- F J Jiménez-Balderas
- Department of Rheumatology, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, México DF, México
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Gardais J. Lymph node disease with lymphocytic abnormal chromatin clumping in a myelodysplastic/myeloproliferative syndrome. J Clin Pathol 1993; 46:177-9. [PMID: 8459040 PMCID: PMC501154 DOI: 10.1136/jcp.46.2.177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A case of abnormal chromatin clumping (ACC) which arose during the course of a myelodysplastic/myeloproliferative syndrome is described in a 61 year old woman who died of haemorrhage 43 months after diagnosis. Mature granulocytes exhibited the same nuclear abnormality described in other patients reported. Unusually, she presented with advanced splenomegaly and lymphadenopathy. This case was the third example of ACC in lymphocytes, the first with clinically confirmed lymphadenopathy. Diagnosis of this subset can be based on: older age; short duration of symptoms; no specific karyotypic damage; non-rearranged bcr; proliferative growth pattern in vitro; numerous circulating myelocytes; profound thrombocytopenia.
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Affiliation(s)
- J Gardais
- Laboratoire de Cyto-Hématologie, Centre Départemental de Transfusion, Angers, France
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Abstract
The t(4;11)(q21;q23) has been associated with marked lineage heterogeneity. Most of the reported cases were classified as acute lymphoblastic leukemia (ALL). The t(4;11) is one of the commonest specific chromosomal translocations in ALL, occurring in 2% of childhood and 5% of adult cases. In childhood ALL, this translocation is associated with female sex, age less than 1 year, hyperleukocytosis, CD10-/CD19+ B-precursor cell immunophenotype, and myeloid-associated antigen (CD15) expression. There also appears to be an age-related difference in treatment outcome. Adults had the worst prognosis, and children aged 1 to 9 years appeared to have a better outcome than infants or adolescents. Reported cases of acute myeloid leukemia (AML) or secondary leukemia with the t(4;11) have not been well characterized. It is intriguing that virtually all of the reported cases with secondary leukemia had received epipodophyllotoxins or doxorubicin, agents that affect topoisomerase II and are associated with secondary AML characterized by 11q23 abnormalities. Identification of the involved gene(s) in the t(4;11) will provide a molecular approach permitting more accurate classification of these cases.
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Affiliation(s)
- C H Pui
- Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, TN 38101-0318
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Meckenstock G, Fonatsch C, Heyll A, Schneider EM, Kögler G, Söhngen D, Aul C, Schneider W. T-cell receptor γ/δ expressing acute leukemia emerging from sideroblastic anemia: Morphological, immunological, and cytogenetic features. Leuk Res 1992; 16:379-84. [PMID: 1373459 DOI: 10.1016/0145-2126(92)90140-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Striking numerical and structural chromosome abnormalities (-Y, +8, i(7q), del (10)(q24), and del (11)(q21)) were detected by cytogenetic analysis in a patient's bone marrow with morphological features of both acute lymphoblastic leukemia and myelodysplastic disorder. Surface marker analysis characterized blast cells to be CD2+ CD7+ CD3+ CD4- CD8- expressing gamma/delta-T-cell receptor antigen and coexpressing CD11b and CD16. Exhibiting an identical phenotype as the leukemic cells, a prominent gamma/delta-TCR+ lymphocyte population was found in the bone marrow as well as in the peripheral blood. Cells of the latter compartment coexpressed CD56 and HLA-DR antigens and exhibited nonspecific cytotoxic activity. In the bone marrow cells NSCA could be induced after stimulation with interleukin 2 in vitro. Morphological, immunological, and cytogenetic findings suggest that gamma/delta-T-ALL emerged from a myelodysplastic disorder after sequential steps of malignant transformation. Leukemic cells with "mixed lineage" character may provide evidence for a common progenitor cell in the bone marrow. Assuming that the leukemic cells represent the malignant counterpart of normal CD3+ gamma/delta-TCR+ cells the results may contribute to our understanding of the origin and differentiation as well as the possible steps of malignant transformation of a gamma/delta-TCR+ lymphocyte population.
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MESH Headings
- Anemia, Sideroblastic/pathology
- Antigens, CD/metabolism
- Antigens, Differentiation, T-Lymphocyte/metabolism
- Bone Marrow/pathology
- CD56 Antigen
- Cell Transformation, Neoplastic/pathology
- Chromosome Aberrations
- Humans
- Immunophenotyping
- Killer Cells, Natural/immunology
- Killer Cells, Natural/pathology
- Male
- Middle Aged
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/immunology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Receptors, Antigen, T-Cell, gamma-delta/metabolism
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Affiliation(s)
- G Meckenstock
- Department of Internal Medicine, Heinrich-Heine University, Düsseldorf, Germany
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Abstract
To date, various models have been proposed to explain the diversification of haemopoietic stem cells along one of at least six pathways of differentiation. Consideration of evidence for and against particular models leads to the conclusion that a precise lineage map for the haemopoietic system is, as yet, unavailable. However, recently available cell and molecular biology techniques provide the means to resolve this problem.
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Affiliation(s)
- G Brown
- Department of Immunology, University of Birmingham, U.K
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MacSween R. Announcements. Histopathology 1986. [DOI: 10.1111/j.1365-2559.1986.tb02551.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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