UNIVERSITAS AIRLANGGA



Detail Article

Indonesian Journal of Clinical Pathology and Medical Laboratory

ISSN 0854-4263

Vol. 21 / No. 1 / Published : 2014-01

Order : 18, and page :96 - 101

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Original Article :

Lineage switch from acute lymphoblastic leukemia to acute myelomonocytic leukemia at a 26 years old woman

Author :

  1. Burhanuddin Said*1
  2. Maimun ZA*2
  3. budiman*3
  1. Patologi Klinik, Fakultas Kedokteran, Universitas Brawijaya/RS. Syaiful Anwar, Malang, Indonesia.
  2. Patologi Klinik, Fakultas Kedokteran, Universitas Brawijaya/RS. Syaiful Anwar, Malang, Indonesia
  3. Patologi Klinik, Fakultas Kedokteran, Universitas Brawijaya/RS. Syaiful Anwar, Malang, Indonesia

Abstract :

A lineage switch from Acute Lymphoblastic Leukemia (ALL) to Acute Myeloid Leukemia (AML) is very rare. It was estimated between 6− 9% of cases that occurred, especially lineage switch from ALL to Acute Myelomonoblastic Leukemia (AMMOL). The reviewers report a case of a 26 years old women with the first clinical presentation were fever and double visions and diagnosed as B-Acute lymphoblastic leukemia ALL with CD13 and CD33 expression aberrations, based on Bone Marrow Aspiration (BMA) and immunoprephenotyping in Hongkong Hospital. After induction therapy, in the second month, BMA was done and found 10% blast, so it couldn’t be assessed as complete remission. After two (2) months, she comes back to Indonesia to follow continuing the treatment. She was suffered from severe headache and blurred vision. The blast cell morphology of BMA showed myeloblast 25% and monoblast 60%, consistent with the diagnosis of AMMOL. Moreover, both findings were quite specific for each common cell ALL and acute myelomonocytic leukemia. These findings support that this case is completely different leukemic clones occurred at each leukemic expression. Exogenic factor such as chemotherapy and endogenic factor due to chromosomal abnormalities is supposed to be the cause of this lineage switch during the treatment Perubahan lineage dari Acute Lymphoblastic Leukemia (ALL) menjadi Acute Myelomonoblastic Leukemia (AML) atau sebaliknya adalah peristiwa tertentu yang jarang terjadi. Diperkirakan hanya antara 6%−9% kasus muncul, khususnya perubahan dari ALL menjadi Acute Myelomonocytic Leukemia (AMMOL). Penelaah melaporkan kasus seorang perempuan yang berumur 26 tahun dengan keluhan utama: demam dan penglihatan ganda serta didiagnosis B-Acute limphoblastic leukemia dengan penyimpangan ekspresi CD 13 dan CD 33, berdasarkan hasil aspirasi sumsum tulang dan imunofenotiping. Setelah diberikan pengobatan imbasan, pada bulan ke-2, dilakukan BMP dan ditemukan sel muda 10%, sehingga belum dapat dikatakan telah mengalami remisi komplit. Dua (2) bulan kemudian, pasien kembali ke Indonesia untuk melanjutkan pengobatan. Pasien mengeluh nyeri kepala berat dan pandangan kabur. Hasil aspirasi sumsum tulang menunjukkan peningkatan granulopoesis dengan myeloblas sebanyak 25% dan monoblas 60%, sesuai untuk diagnosis AMMOL. Kedua penemuan ini khas untuk ALL dan AMMOL. Kasus ini menunjukkan ada perubahan lineage yang komplit di leukemia. Faktor eksogen seperti pemberian kemoterapi dan faktor endogen seperti kelainan kromosom diduga merupakan penyebab diferensiasi sel leukemi terjadi selama pengobatan. Faktor eksogen seperti eksogen dan faktor eksogen seperti kelainan kromosom diduga dapat mengubah program diferensiasi sel leukemik, sehingga menyebabkan perubahan fenotip pada saat pengobatan. Tujuan penulisan ini adalah untuk lebih memahami patofisiologi lineage switch ALL menjadi AMMOL dan lebih memberikan perhatian pada managemen pengobatannya.

Keyword :

Lineage switch, acute lymphoblastic leukemia, acute myelomonoblastic leukemia, bone marrow aspiration,


References :

Park M, Koh K N, Kim B, Im H J, Jang S, Park C J, Seo J J,(2011) Lineage Switch at relaps of childhood acute leukemia: A report of four cases Vol.26 No.6, Hal: 829–831. : J Korean Med Sci

Tamai H, Inokuchi K,(2010) 11q23/MLL acute leukaemia: Update of clinical aspects. Vol. 50 No.2 Hal: 91–98. : J. Clin.Exp





Archive Article

Cover Media Content

Volume : 21 / No. : 1 / Pub. : 2014-01
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  2. Correlation Plasma Fibrinogen With Intima-media Thickness Of Carotid Artery In Diabetes Mellitus
  3. Matrix Metalloproteinase-2 In Breast Cancer Metastastis
  4. Potassium In Multidrug Resistance Tuberculosis With Kanamycin
  5. Safe Blood And Voluntary Non-remunerated Blood Donors
  6. Mean Platelet Volume In Diabetes Mellitus
  7. Ratio Of Urinary Uric Acid Levels And Serum Uric Acid In Type 2 Diabetes Mellitus
  8. Reticulocyte Hemoglobin Level Of Absolute Iron Deficiency Anemia And Nonabsolute Iron Deficiency Anemia In End State Renal Disease Undergoing Maintenance Hemodialysis
  9. Immature Platelet Fraction In Dengue Fever And Dengue Hemorrhagic Fever
  10. Cryptococcal Antigen Of Acquired Immune Deficiency Syndrome With Lateral Flow Assay And Cryptococcus Antigen Latex Agglutination System
  11. T-cd4+ And Lipid Profile In Hiv)
  12. Liver Function Parameters Based On Degree Of Liver Fibrosis In Chronic Liver Disease
  13. Brain Derived Neurotrophic Factor (bdnf) As A Prognostic Factor In Severe Head Injury
  14. Hpv Genotype And Hpv Infection Pattern Related To The Histopathological Type Of Cervical Cancer)
  15. Glut 4 In Adipose Tissue
  16. The Diagnostic Value Of Anti Dengue Iga And Anti Dengue Igm/igg In Dengue Virus Infection)
  17. Vitamin D Deficiency And Diseases
  18. Lineage Switch From Acute Lymphoblastic Leukemia To Acute Myelomonocytic Leukemia At A 26 Years Old Woman
  19. The Role For Clinical Pathologist In Hospital Accreditation

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