Abstract
In a small percentage of patients with acute leukemia, conversion of cell lineage can occur at relapse.1 Such conversion of cell lineage usually concerns a switch from precursor-B-acute lymphoblastic leukemia (ALL) to acute myeloid leukemia (AML) and is most frequently assumed to represent a therapy-related secondary malignancy.2 However, true lineage switches of clonally related leukemic cells have also been described.3, 4 To establish a true lineage switch (i.e. the leukemic cells at diagnosis and at relapse are clonally related), molecular techniques such as analysis of immunoglobulin (Ig) and/or T-cell receptor (TCR) genes are required. The exact mechanism resulting in a true lineage switch are still not understood, but possible explanations include the preferential outgrowth of a minor AML subclone present at diagnosis, a true therapy-induced immunophenotypic shift or outgrowth of an undifferentiated pre-leukemic clone.
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