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Unusual immunophenotypic shift in a patient with T-cell acute lymphoblastic leukemia

Leukemia volume 20, pages 1626–1629 (2006)Cite this article

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.

A chest radiograph revealed a pleural effusion in the right hemithorax. The pleural fluid showed small- to medium-sized blasts (Figure 1a). These cells were immunophenotypically similar to the malignant blasts in the bone marrow, indicative of a pleural localization of the T-ALL. The myeloperoxidase staining was negative. Computed tomography (CT) scanning of the neck, chest and abdomen showed a pathologic lymphoma in the right axilla, a pathologic mass in the cardiomediastinum with in-growth of the pericardium and encasement of the truncus pulmonalis, the left pulmonary vein and the left atrium and the right hilus with complete collapse of right lung, massive pleural effusion of the right hemithorax and retroperitoneal lymphadenopathy. Repeated morphologic and immunophenotypic analysis of the liquor cerebrospinalis did not show any evidence of leptomeningeal T-ALL localization.

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Authors and Affiliations

  1. Department of Immunology, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands

    V H J van der Velden & P G Hoogeveen

  2. Department of Hematology, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands

    K van Lom & D A Breems

  3. Department of Clinical Genetics, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands

    H B Beverloo

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  1. V H J van der Velden
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Correspondence to V H J van der Velden.

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van der Velden, V., van Lom, K., Hoogeveen, P. et al. Unusual immunophenotypic shift in a patient with T-cell acute lymphoblastic leukemia. Leukemia 20, 1626–1629 (2006). https://doi.org/10.1038/sj.leu.2404297

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