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Hematology Reports
Volume 4
Issue 3
10.4081/hr.2012.e15
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Hematology Reports is published by MDPI from Volume 14 Issue 1 (2022). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with PAGEPress.
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Case Report

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

by
Giovanni Carulli
1,*,
Alessandra Marini
2,
Maria I. Ferreri
3,
Antonio Azzarà
1,
Virginia Ottaviano
1,
Tiziana Lari
2,
Melania Rocco
1,
Stefano Giuntini
1 and
Mario Petrini
1
1
Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa-Santa Chiara Hospital, 56126 Pisa, Italy
2
Laboratory of Clinical Pathology, Versilia Hospital, 55049 Lido di Camaiore LU, Italy
3
Laboratory of Cytogenetics, AOUP, Pisa, Italy
*
Author to whom correspondence should be addressed.
Hematol. Rep. 2012, 4(3), e15; https://doi.org/10.4081/hr.2012.e15
Submission received: 6 March 2012 / Revised: 19 April 2012 / Accepted: 20 May 2012 / Published: 6 September 2012

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, CD4dim) 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 intravas- cular 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.
Keywords: acute lymphoblastic leukemia; acute myeloid leukemia; mixed phenotype acute leukemia; MLL gene; t(4; 11)(q21; q23) acute lymphoblastic leukemia; acute myeloid leukemia; mixed phenotype acute leukemia; MLL gene; t(4; 11)(q21; q23)

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MDPI and ACS Style

Carulli, G.; Marini, A.; Ferreri, M.I.; Azzarà, A.; Ottaviano, V.; Lari, T.; Rocco, M.; Giuntini, S.; Petrini, M. 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. Hematol. Rep. 2012, 4, e15. https://doi.org/10.4081/hr.2012.e15

AMA Style

Carulli G, Marini A, Ferreri MI, Azzarà A, Ottaviano V, Lari T, Rocco M, Giuntini S, Petrini M. 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. Hematology Reports. 2012; 4(3):e15. https://doi.org/10.4081/hr.2012.e15

Chicago/Turabian Style

Carulli, Giovanni, Alessandra Marini, Maria I. Ferreri, Antonio Azzarà, Virginia Ottaviano, Tiziana Lari, Melania Rocco, Stefano Giuntini, and Mario Petrini. 2012. "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" Hematology Reports 4, no. 3: e15. https://doi.org/10.4081/hr.2012.e15

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