Immunotherapy- (Blinatumomab-) Related Lineage Switch of KMT2A/AFF1 Rearranged B-Lymphoblastic Leukemia into Acute Myeloid Leukemia/Myeloid Sarcoma and Subsequently into B/Myeloid Mixed Phenotype Acute Leukemia.

IF 0.7 Q4 HEMATOLOGY Case Reports in Hematology Pub Date : 2019-12-07 eCollection Date: 2019-01-01 DOI:10.1155/2019/7394619

Rui R He, Zacharia Nayer, Matthew Hogan, Raymund S Cuevo, Kimberly Woodward, David Heyer, Christine A Curtis, Jess F Peterson

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引用次数: 20

Abstract

The presence of KMT2A/AFF1 rearrangement in B-lymphoblastic leukemia (B-ALL) is an independent poor prognostic factor and has been associated with higher rate of treatment failure and higher risk of linage switch under therapy. Blinatumomab has shown promising therapeutic results in refractory or relapsed B-ALL; however, it has potential risk of inducing lineage switch, especially in KMT2A/AFF1 rearranged B-ALL into acute myeloid leukemia and/or myeloid sarcoma. We report a 40-year-old female with KMT2A/AFF1-rearranged B-ALL that was refractory to conventional chemotherapy. Following administration of blinatumomab, she developed a breast mass proven to be myeloid sarcoma, in addition to bone marrow involvement by AML. Approximately six weeks after cessation of blinatumomab, a repeat bone marrow examination revealed B/myeloid MPAL.

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免疫治疗- (blinatumumab -)相关谱系开关KMT2A/AFF1重排B淋巴母细胞白血病为急性髓系白血病/髓系肉瘤，随后为B/髓系混合表型急性白血病

KMT2A/AFF1重排在b淋巴母细胞白血病(B-ALL)中的存在是一个独立的不良预后因素，并且与更高的治疗失败率和更高的治疗谱系转换风险相关。Blinatumomab在难治性或复发性B-ALL中显示出有希望的治疗效果;然而，它有诱导谱系转换的潜在风险，特别是在KMT2A/AFF1将B-ALL重排为急性髓性白血病和/或髓性肉瘤时。我们报告一例40岁女性KMT2A/ aff1重排B-ALL，常规化疗难治性。在给予blinatumomab后，她出现了一个乳房肿块，证实是髓系肉瘤，此外还有AML累及骨髓。停用blinatumab约6周后，复查骨髓检查显示B/髓系MPAL。

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