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Case Rep Hematol. 2019 Dec 7;2019:7394619. doi: 10.1155/2019/7394619. eCollection 2019.

Immunotherapy- (Blinatumomab-) Related Lineage Switch of KMT2A/AFF1 Rearranged B-Lymphoblastic Leukemia into Acute Myeloid Leukemia/Myeloid Sarcoma and Subsequently into B/Myeloid Mixed Phenotype Acute Leukemia.

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Department of Pathology, Inova Fairfax Hospital, Falls Church, VA, USA.
School of Medicine, George Washington University, Washington, DC, USA.
School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
Inova Schar Cancer Institute, Inova Fairfax Hospital, Falls Church, VA, USA.
Department of Cytogenetics, Quest Diagnostics Nichols Institute, Chantilly, VA, USA.
Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.


The presence of KMT2A/AFF1 rearrangement in B-lymphoblastic leukemia (B-ALL) is an independent poor prognostic factor and has been associated with higher rate of treatment failure and higher risk of linage switch under therapy. Blinatumomab has shown promising therapeutic results in refractory or relapsed B-ALL; however, it has potential risk of inducing lineage switch, especially in KMT2A/AFF1 rearranged B-ALL into acute myeloid leukemia and/or myeloid sarcoma. We report a 40-year-old female with KMT2A/AFF1-rearranged B-ALL that was refractory to conventional chemotherapy. Following administration of blinatumomab, she developed a breast mass proven to be myeloid sarcoma, in addition to bone marrow involvement by AML. Approximately six weeks after cessation of blinatumomab, a repeat bone marrow examination revealed B/myeloid MPAL.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

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