Rapid development of acute monocytic leukemia (AML-M5b) with t(9;11)(p22;q23) after chemotherapy for T-cell lymphoblastic lymphoma: A case report
Jiao Cai,
Nan Zhang,
Ling Qiu,
Bai-tao Dou,
Meng-jiao Li,
Dan Chen,
Shi-hui Ren,
Lei Ma,
Hao Yao,
Fang-yi Fan
Affiliations
Jiao Cai
Department of Hematology, Chinese People's Liberation Army The General Hospital of Western Theater Command, Chengdu, SiChuan, 610083, China
Nan Zhang
Department of Hematology, Chinese People's Liberation Army The General Hospital of Western Theater Command, Chengdu, SiChuan, 610083, China
Ling Qiu
Department of Hematology, Chinese People's Liberation Army The General Hospital of Western Theater Command, Chengdu, SiChuan, 610083, China
Bai-tao Dou
Department of Hematology, Chinese People's Liberation Army The General Hospital of Western Theater Command, Chengdu, SiChuan, 610083, China; Department of Clinical Medicine, North Sichuan Medical College, Nanchong, SiChuan, China
Meng-jiao Li
Department of Hematology, Chinese People's Liberation Army The General Hospital of Western Theater Command, Chengdu, SiChuan, 610083, China; Department of Clinical Medicine, North Sichuan Medical College, Nanchong, SiChuan, China
Dan Chen
Department of Hematology, Chinese People's Liberation Army The General Hospital of Western Theater Command, Chengdu, SiChuan, 610083, China
Shi-hui Ren
Department of Hematology, Chinese People's Liberation Army The General Hospital of Western Theater Command, Chengdu, SiChuan, 610083, China
Lei Ma
Department of Hematology, Chinese People's Liberation Army The General Hospital of Western Theater Command, Chengdu, SiChuan, 610083, China
Hao Yao
Department of Hematology, Chinese People's Liberation Army The General Hospital of Western Theater Command, Chengdu, SiChuan, 610083, China; Department of Clinical Medicine, North Sichuan Medical College, Nanchong, SiChuan, China; Department of Hematology, General Hospital of the Chinese People's Liberation Army Western Theatre, No. 270, Rongdu Avenue, Chengdu, Sichuan Province, 610083, China.
Fang-yi Fan
Department of Hematology, Chinese People's Liberation Army The General Hospital of Western Theater Command, Chengdu, SiChuan, 610083, China; Department of Clinical Medicine, North Sichuan Medical College, Nanchong, SiChuan, China; Department of Hematology, General Hospital of the Chinese People's Liberation Army Western Theatre, No. 270, Rongdu Avenue, Chengdu, Sichuan Province, 610083, China.
Objective: To investigate the diagnosis and treatment of T lymphoblastic lymphoma (T-LBL) progressing into acute monocytic leukemia (AML-M5b) and explore possible pathogenic mechanisms. Methods: Comprehensive diagnosis and evaluation of the patient's disease status were conducted through lymph node biopsy, bone marrow aspiration and biopsy, PET/CT, immunohistochemistry, flow cytometry, fusion gene detection, and whole-exome sequencing (WES) based on the clinical manifestations at different stages. Results: The lymph node biopsy revealed Ki67 positivity at 80 % and expression of TDT, CD4, CD8, CD3, and CD5. The PET/CT scan showed increased FDG metabolism at multiple sites. Based on relevant tests and examination results, the patient was diagnosed with T-LBL (stage IV; IPI score, 3). After three cycles of chemotherapy, abnormal immature monocytes were detected using bone marrow flow cytometry, suggesting an acute progression from T-LBL to AML-M5b. Chromosomal karyotype analysis revealed t(9; 11)(p22; q23) and the MLL-AF9 fusion gene. WES analysis identified mutations in several genes, among which mutations in SET domain-containing protein 2 and CBL may be associated with the occurrence of acute myeloid leukemia. The patient died 1 month after AML-M5b diagnosis. Conclusion: Patients with T-LBL progression to AML have a poor prognosis and shorter overall survival. Hence, exploring the pathogenic mechanisms and reasons for disease progression has significant implications for finding effective treatment modalities and prolonging patient survival.
