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CASE REPORT article
Front. Oncol.
Sec. Hematologic Malignancies
Volume 14 - 2024 |
doi: 10.3389/fonc.2024.1457832
Case report: An intriguing case of Philadelphia chromosome-positive acute lymphoblastic leukemia recurrence
Provisionally accepted- 1 Tettamanti Center, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- 2 Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- 3 School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
- 4 Division of Pediatric Oncology/Hematology, Children's Hospital A. Meyer IRCCS, Florence, Italy
The incorporation of tyrosine kinase inhibitors (TKIs) in the treatment of Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) led to significant improvement. However, in the pediatric setting the outcomes of Ph+ ALL are still inferior compared to other ALL subtypes even in the TKI era due to higher relapse rate. Herein, we report a very peculiar case of late extramedullary Ph+ ALL relapse in a child, characterized by lymphomatous presentation in the tonsils and lymphoid lineage switch. The diagnostic dilemma between the occurrence of a second malignant neoplasm and the recurrence of the primary disease is further discussed, highlighting the importance of molecular backtracking analysis. This case report emphasizes the high plasticity and polyclonal nature of ALL and expands the heterogeneity of possible clinical presentation of Ph+ ALL at relapse.
Keywords: Acute Lymphoblastic Leukemia, Philadelphia (Ph)/BCR-ABL positive, e1a3, BCR::ABL1, Extramedullary relapse, second malignant neoplasm (SMN), T-cell lymphoblastic leukemia or lymphoma, Ig/TCR gene rearrangement
Received: 01 Jul 2024; Accepted: 15 Jul 2024.
Copyright: © 2024 Peccatori, Chiocca, Conter, Tondo, Marzorati, Casini, Veltroni, Biondi and Fazio. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Nicolò Peccatori, Tettamanti Center, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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