“Multiple Lineage-switches in a pediatric case with a KMT2A-AFF1
positive Acute Lymphoblastic Leukemia:
Abstract
We report a case with multiple lineage switches, a rare event that
mostly occurred in infants, in a ten-year-old girl with
KMT2A-AFF1 positive ALL. Although she received standard
chemotherapy, immunotherapy and hematopoietic stem cell transplantation
(HSCT), the leukemic clone continuously switched on AML or ALL,
maintaining immunoglobulin/T-cell receptor (IG/TR) rearrangements and
showing a high grade of therapy-escaping. Since other genes are involved
in this event, considering the selective pressure imposed by the applied
treatment, it is mandatory to characterize the cell-of-origin that is
capable to proliferate towards both lineages in the attempt to design a
targeted therapy.