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Bone Marrow Research
Volume 2012 (2012), Article ID 406796, 18 pages
Review Article

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

1Leukemia Clinic, Mexican Children’s Hospital Federico Gómez, 06720 Mexico City, DF, Mexico
2Oncology Research Unit, Oncology Hospital, Mexican Institute of Social Security, 06720 Mexico City, DF, Mexico
3Medical Sciences Program, National Autonomous University of Mexico, 04510 Mexico City, DF, Mexico

Received 10 March 2012; Accepted 8 May 2012

Academic Editor: Amanda C. LaRue

Copyright © 2012 Elisa Dorantes-Acosta and Rosana Pelayo. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Acute leukemias are the most common cancer in childhood and characterized by the uncontrolled production of hematopoietic precursor cells of the lymphoid or myeloid series within the bone marrow. Even when a relatively high efficiency of therapeutic agents has increased the overall survival rates in the last years, factors such as cell lineage switching and the rise of mixed lineages at relapses often change the prognosis of the illness. During lineage switching, conversions from lymphoblastic leukemia to myeloid leukemia, or vice versa, are recorded. The central mechanisms involved in these phenomena remain undefined, but recent studies suggest that lineage commitment of plastic hematopoietic progenitors may be multidirectional and reversible upon specific signals provided by both intrinsic and environmental cues. In this paper, we focus on the current knowledge about cell heterogeneity and the lineage switch resulting from leukemic cells plasticity. A number of hypothetical mechanisms that may inspire changes in cell fate decisions are highlighted. Understanding the plasticity of leukemia initiating cells might be fundamental to unravel the pathogenesis of lineage switch in acute leukemias and will illuminate the importance of a flexible hematopoietic development.