Verdeguer A, Ruiz J G, Ferris J, Esquembre C, Tasso M J, Fernandez J M, Prieto F, Castel V
Pediatric Oncology Unit, Hospital Infantil La Fe, Valencia, Spain.
Med Pediatr Oncol. 1992;20(1):48-52. doi: 10.1002/mpo.2950200110.
Some cases of conversion from acute lymphoblastic leukemia (ALL) to acute nonlymphoblastic leukemia (ANLL) at relapse have been reported recently. We report three cases initially diagnosed as having ALL and showing morphological, cytochemical, and immunophenotypic features of ANLL at relapse (lineage switch). Conversion was observed among 14 patients who developed bone marrow relapse while undergoing intensive treatment with our ALL protocol, which includes teniposide, and that had been administered to 62 patients. The three cases converted at first relapse, with a mean time of 20 months (13-29 months). Clinical and immunologic characteristics of T-cell leukemia were present in one patient. Changes documented in cytogenetic studies are discussed. The underlying mechanisms for the lineage switch remain unclear as does its relation with mixed lineage leukemias, but we believe that drugs employed in our therapy protocol could have had an influence on this conversion.
最近有报道称，一些急性淋巴细胞白血病（ALL）患者在复发时会转变为急性非淋巴细胞白血病（ANLL）。我们报告了3例最初诊断为ALL的患者，这些患者在复发时（谱系转换）表现出ANLL的形态学、细胞化学和免疫表型特征。在14例接受包含替尼泊苷的ALL强化治疗方案的患者中观察到了这种转变，该方案已应用于62例患者。这3例患者均在首次复发时发生转变，平均时间为20个月（13 - 29个月）。1例患者具有T细胞白血病的临床和免疫学特征。本文讨论了细胞遗传学研究中记录的变化。谱系转换的潜在机制及其与混合谱系白血病的关系尚不清楚，但我们认为我们治疗方案中使用的药物可能对这种转变产生了影响。
