Review Article

Lineage Switching in Acute Leukemias: A Consequence of Stem Cell Plasticity?

Table 2

Pediatric cases of lineage switching in acute leukemias.

Number of case Age SexDiagnosisImportant findings Time from first diagnosis to relapse Time from second diagnosis to relapse Criteria for lineage switching Clinical outcome References
1st diagnosis2nd diagnosis at relapse3rd diagnosis at second relapse1st diagnosis2nd diagnosis at relapse3rd diagnosis at second relapse

1NeonateFALL L1AML M546 XX t(1;6), t(4;11)
CD19+
CD22+
CD79a+,
MPO−
CD34−
CD117−
46 XX t(1;6), t(4;11)
CD19−
CD22−
CD79a−
CD14+
CD33+
CD13+
Day 100 after induction of chemotherapyMorphologic and immunophenotypicDied[31]

2At birthFAML M5B-ALL L1t(9;11)Karyotype NR12 moMorphologicAlive[32]

3At birthFAML M5B-ALLt(4:11)
MPO−
CD33+
CD13+
HLA-DR+
CD14+
t(4:11)
CD34+
CD19+
CD22+
HLADR+
CD10−
18 dyMorphologic and immunophenotypicDied[33]

412 dy?B-ALLAML M5MLL rearrangementMLL rearrangement7 dyMorphologicNR[34]

521 dyMPro-B ALLAMLt(4;11)
MPOX−
CD10–
CD19+
CD22+
CD34+
CD38+
t(4;11)
CD20+
CD13+
CD14+
CD15+
CD33+
CD41+
CD61+
8 dyMorphologic and immunophenotypicDied[35]

63 moFPre-B cell ALL L1AML M4t(4;11)
PAS+
MPO−
ANBE−
CD19+
CD34+
TdT+
CD33+
FISH with MLL signal
MPO+
ANBE+
CD2+
CD13+
CD14+
CD33+
CD41+
CD65+
2 moMorphologic and immunophenotypicAlive after allo-HSCT[36]

79 moMALLAML M5bt(11;16)t(11;16)8 moMorphologicDied[37]

815 moM pro-B ALL L1AML M046 XY.
CD19+
HLA-DR+
46 XY t(9;11)
MPO−
CD33+
cyCD13+
cyCD33+
CD117+
76 moMorphologic, immunophenotypic and cytogeneticAlive after allo-HSCT [36]

925 mo?AMLALL L146 XY (11q23)
PAS+
MPO−
Normal karyotype1 yrMorphologic and cytogeneticAlive[38]

104 yrMAML M5ALL pro-BNormal karyotype
PAX 5 negative when patient was under surveillance
CD10−
CD19−
CD13+
CD14+
CD15+
Normal karyotype
CD10+
CD19+
CD13−
CD14−
CD15−
9 moMorphologic and immunophenotypicDied[39]

114 yrFALL L1AML moBM: ALL L1
CNS: AML mo
Normal karyotype
BM: MPO–
BM: CD13+
CD19+
D22+
CD33+
CD38+
CD34+
HLA DR+
BM: MPO+Karyotype
47XX+ 18
BM: MPO–
BM: CD13−
CD19+
D22 NR
CD33+
CD38 NR
CD34 NR
HLA DR+
2 yr after complete remission1 moMorphologic and immunophenotypicDied[40]

126 yrM B-lineage common cell ALL L1AML M456 XY
HLA-DR+
TdT+
CD10+
CD19+
CD22+
46 XY
t(8;16)
MPO+
ANBE+
HLA-DR+
CD13+
CD14+
CD33+
9 moMorphologic, immunophenotypic, and cytogeneticAlive[36]

137 yrFB-lineage ALL L2T cell ALLAML M146, XX
MPO−
HLA-DR+,
cyIgM+
CD33.+
PAS+
NSE−
Trisomy 13
CD2+
CD5+
CD7+
CD34+
HLA-DR+
CD33+
ANBE−.
MPO+.
CD13+,
CD33+,
CD34+
HLA-DR+ CD7+
14 mo45 dyMorphologic, immunophenotypic and cytogeneticDied[36]

148 yrMAMLALLKaryotype NRNormal karyotype13 moMorphologicAlive[41]

159 yrMALL L1AML M456 XY46 XY
t(8;16)
9 moMorphologic and cytogeneticAlive[42]

1613 yrFCommon B-cell ALLAML M4/M5t(12;21)
amplification of RUNX1
Amplification of RUNX15 yrMorphologicAlive[43]

1716 yrFT-cell ALLAML M046 XX
MPO−
CD7+
CD4−
CD8−
CD1−
TdT+
,
XX, + X,
MPO−
CD19+
CD117+
CD33+
CD34+
CD56+
13 moMorphologic, immunophenotypic, and cytogeneticDied[44]

1820 yrMT-ALLAML52 XY
MPO−
cytCD3+,
CD5+
CD2+
TdT+
CD7+
CD3−
CD1a−
CD10−
CD33−
CD117−
CD19−
CD13±
MPO−
CD117+
CD33+
CD13+
CD56+
TdT−
CD7−
cyCD3−
CD2−
CD5−
CD19+
21 moMorphologic and immunophenotypicDied[45]

M: male, F: female, BM: bone marrow, CNS: central nervous system, FISH: fluorescence in situ hybridization, ANBE: α-naphthyl-butyrate esterase, PAS: periodic acid-Schiff, NSE: nonspecific esterase, MPO: myeloperoxidase, TdT: terminal deoxynucleotide transferase, yr: year, mo: months, dy: days, cy: cytoplasmic, and NR: not reported.