T ALL relapsing as AML?
Anna Porwit-MacDonald (anpo@mb.ks.se)
Wed, 14 May 1997 11:08:10 +0200
Dear Flow..ers,
I wonder if you could help me with your comments on a leukemia case we
received yesterday:
A girl born 1985, was diagnosed with T-ALL, cytology L2, January 1996. AT
diagnosis the Hb was 64, WBC 528 (sic!) , 96% blasts, and Plt 20. She had
generalized lymphadenopathy. The immunophenotype was as follows:
96% of cells were in the lymphocyte gate, 92% were positive for
TdT+, cytCD3+, mCD3 dim, CD7 bright, CD5+, CD2dim, HLA-DR neg. Moreover
CD4+ was on 40% of blasts, CD8 neg, CD34 17%, CD33: 37%, CD13:16%, CD15
neg., CD10 16%, CD19 neg, CD22 neg, CD20 neg. TCR analysis showed
rearrangement of TCR gamma (family 2) and TCR delta. The child was treated
according to high-risk ALL protocol and morphological CR was obtained at day
29 control. She was also in morphological CR at 6months control.
Yesterday (approx. 16 months after diagnosis, under treatment) the blood
tests showed Hb 117, WBC 0,7, Plt 96. The bone marrow smear showed 72% of
blasts. Imunophenotyping showed: 70% of cells in blasts gate, FSC and SSC
suggesting larger cells than at diagnosis, Cyt CD3 neg, mCD3 neg, CD5 neg,
CD19 neg, CD22 neg, CD20 neg,CD2 neg, CD4 neg, CD8 neg, HLA-DR neg, but 84%
positive for CD34 bright, CD7 bright, CD33 bright, Tdt pos., CD13 17% dim,
CD15 neg.
We looked again at the results from diagnosis, but since 92% of cells in
blast gate were then positive for CD5, cyt.CD3 andCD7 it was difficult to
evaluate if a population similar to the relapsed immunophenotype was present
at diagnosis.
Has anyone of you seen a similar case before?
Thank you for any comments!
Anna
Anna Porwit-MacDonald MD, PhD
Haematopathology Lab.,
Department of Pathology
Karolinska Hospital
Stockholm, Sweden
anpo@mb.ks.se
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