Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Korean Med Sci. 2011 Jun;26(6):829-31. doi: 10.3346/jkms.2011.26.6.829. Epub 2011 May 18.
Lineage switch in acute leukemia is an uncommon event at relapse, and therefore rarely reported in the literature. Here, we have described the clinical laboratory features of four cases in which the cell lineage switched from acute lymphoblastic leukemia (ALL) to acute myeloid leukemia (AML). One patient was initially diagnosed with B-ALL, switched to T-ALL at the first relapse, and eventually, AML at the second relapse. A lineage switch represented either relapse of the original clone with heterogeneity at the morphologic level or emergence of a new leukemic clone. Further sequential phenotypic and cytogenetic studies may yield valuable insights into the mechanisms of leukemic recurrence, with possible implications for treatment selection.
白血病中的谱系转换在复发时较为罕见，因此在文献中鲜有报道。本研究描述了四例由急性淋巴细胞白血病（ALL）转换为急性髓系白血病（AML）的病例的临床实验室特征。其中一例患者初诊为 B-ALL，第一次复发时转换为 T-ALL，最终第二次复发时发展为 AML。这种谱系转换可能代表原始克隆的异质性复发，或者是新白血病克隆的出现。进一步的连续表型和细胞遗传学研究可能有助于深入了解白血病复发的机制，并可能对治疗选择产生影响。
