An extremely rare lineage switch from T-cell lymphoblastic lymphoma into B-cell acute lymphoblastic leukemia at relapse

Abstract

Lymphoblastic leukemia/lymphoblastic lymphoma (ALL/LBL) is a neoplasm of precursor B or T-cells. These neoplastic cells may infiltrate bone marrow and peripheral blood (acute lymphoblastic leukemia) or their presence is confined to nodal or extranodal sites with only minimal evidence of blood and bone marrow involvement (lymphoblastic lymphoma). Herein, we report a male patient with infrequent neurological manifestation of T-LBL who failed autologous hematopoietic stem cell transplantation (AHSCT). A lineage switch from T-cell lymphoblastic lymphoma into B-cell acute lymphoblastic leukemia was observed at relapse and this phenomenon has not been described so far. Our case demonstrates difficulties which may occur in diagnosis and treatment of LBL/ALL. It should be underlined that neurological deficits resulting from spinal cord compression may be the first symptom of lymphoma. A switch within the lymphoblastic line may occur but it is an extremely rare finding. Its pathogenesis remains unclear, therefore further studies are highly required.