6020 POSTER Prevalence of hepatitis C virus infection in B-cell non Hodgkin lymphoma patients in India

Abstract

Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy, representing 25% of childhood cancers, with a peak prevalence between 2 and 9 years. Conversions of the leukemic cell lineage throughout the duration of the disease is a rare manifestation, accounting for 6–9% of relapsed cases and being more frequently observed in pediatric patients. We present a case of a patient with a lineage switch from lymphoblastic leukemia to myeloid leukemia.A 60-year-old male was seen due to pancytopenia, weight loss and weakness. Initial laboratory work-up was performed. Bone and marrow aspirate flow cytometric analysis disclosed pre-B lymphoblastic acute leukemia BCR ABL (−), 46 XY, hyperdiploid, CD20(−), CD 10 (−), CD19 (+), CD33 (−), CD34 (+), CD38 (+), CD79a (+), TdT (+), IgS(−), CD45 (+/−), HLA-DR (+), MLL (−), FLT3 (−), TEL AML (−). He was treated with a pediatric-inspired TOTAL XI schedule. Sixty days afterward, induction blasts appeared in the peripheral blood, but immunophenotyping was not conclusive for MRD+ status. One week later, he presented blasts in the peripheral blood compatible with acute myeloid leukemia. CD7 (+−), CD13 (+), CD14 (−), CD15(−), CD33(+), CD34(+), CD38(+), CD45(+−), CD64(−), CD117(+), HLA-DR heterogenous. BCR-ABL, PML-RAR alfa, and FLT-3 were repeated in peripheral blood when AML developed and was negative. The patient started subcutaneous cytarabine and was alive 90 days after initial diagnosis with active AML leukemia.There is a small number of reports of lineage conversion in the literature, probably because immunophenotyping is performed at diagnosis without a follow up.