Case Report

Relapse after Prolonged Remission in Philadelphia-Like Acute Lymphoblastic Leukemia

Table 1

Summary of hematological and flow cytometry findings, molecular aberrations, and cytogenetics at various stages of clinical course.

RelapsePostcycle 1 blinatumomabBlinatumomab treatment failurePostcycle 1 inotuzumab ozogamicinPrior to AlloHSCT

WBC in 103/mm3 (blast percentage)44 (54%)7.51 (5%)108 (79%)7.45 (0%)6.45 (0%)
Platelet count (103/mm3)24.6158112194167
Flow cytometryPrecursor B-ALL (76% blast)Precursor B-ALL (32% blast)Precursor B-ALL (79% blast)No evidence of ALLNo evidence of ALL
Bone marrow diagnosisAspirate: 85% blastsAspirate: 41% blastsNot performedAspirate/core: no morphologic or phenotypic evidence of B-ALLAspirate/core: no morphologic or phenotypic evidence of B-ALL
Pertinent CD markers on bone marrow (peripheral blood at blinatumomab treatment failure)CD19+, CD10 high, CD45 low, CD34±, CD20+, zCD9+, CD38+, CD58+, sIg−, CD5−, CD22+, CD13−/low, and CD33−CD19+, CD10 high, CD45 low, CD34±, CD20+, CD22+, CD38+, CD58+, sIg−, CD13−, and CD33−CD19+, CD20+, CD10hi, CD45lo, CD34 heterogeneous, CD117−, CD22+, CD38+, CD58lo, CD9+, surface Ig−, CD13−, and CD33−
CRLF2 rearrangement at Xp22.33/Yp11.3286% of cells positive40% of cell positive76% of cell positiveNegativeNegative
Karyotype46,XY,t(3;12)(q21;q24) [20]46,XY,t(3; 12)(q21;q24.1) [20]46,XY,t(3; 12)(q21;q24.1) [20]46,XY,t(3; 12)(q21;q24.1)c [20]46,XY,t(3; 12)(q21;q24.1)c [20]
Pertinent molecular genetics1 copy of the pathogenic variant in the kinase region of the JAK2 geneFusion of PAX5-ZCCHC7. Mutation in JAK2, CHD2, FIP1L1, and KDM6A