Abstract
Biphenotypic acute leukemias (BAL) account for less than 4% of all cases of acute leukemia. Philadelphia chromosome and 11q23 rearrangement are the most frequently found cytogenetic abnormalities. Since t(15;17) is almost always associated with acute promyelocytic leukemia, t(15;17) in BAL cases is extremely uncommon. We report here a rare and instructive case of BAL with t(15;17) and the successful treatment approach adopted. A 55-year old woman was referred to our hospital for an examination of elevated white blood cell (WBC) counts with blasts (WBC 13.4×109/L; 76% blasts). The blasts with acute lymphoblastic leukemia (ALL-L2, FAB) morphology co-expressed B-lymphoid and myeloid lineages, and a cytogenetic study revealed 4q21 abnormalities and t(15;17). However, promyelocytic-retinoid acid receptor α rearrangement was not detected by fluorescence in situ hybridization on interphase nuclei. Our patient was treated with chemotherapy for ALL and gemtuzumab ozogamicin without all-trans-retinoic acid, and has remained in hematologic first complete remission for more than 3.7 years.
Highlights
A 55-year old Japanese woman was referred to our hospital with elevated white blood cell (WBC) counts with blasts
The patient was initially treated with the Japan Adult Leukemia Study Group (JALSG)ALL202 chemotherapy protocol (Table 1) and induction for ALL treatment was completed
The therapy using the JALSG protocol until two rare and account for less than 4% of all cases immunophenotype analysis was conclusive for years after the onset of disease, during which of acute leukemia
Summary
A 55-year old Japanese woman was referred to our hospital with elevated white blood cell (WBC) counts with blasts. Her laboratory data on admission showed rising WBC counts (13.4×109/L; 76% blasts, 1% band, 6% segmented, 16% lymphocytes, 1% monocytes) with anemia and thrombocytopenia (hemoglobin 9.3 g/dL and platelets 110×109/L). We detected differences in the size of the blasts, corresponding to an abnormal lymphocyte-like cell population with a high nuclear/cytoplasmic (N/C) ratio, but without granules in the cytoplasm (Figure 1). These blasts were negative for myeloperoxidase (MPO) and esterase. Morphological findings were compatible with acute lymphoblastic leukemia (ALL-L2, FAB classification)
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