Biphenotypic acute leukemia with t(15;17) lacking promyelocytic-retinoid acid receptor α rearrangement

  • Makoto Saito | ikyoku@aiiku-hp.or.jp Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo, Japan.
  • Koh Izumiyama Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo, Japan.
  • Akio Mori Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo, Japan.
  • Tatsuro Irie Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo, Japan.
  • Masanori Tanaka Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo, Japan.
  • Masanobu Morioka Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo, Japan.
  • Manabu Musashi Department of Internal Medicine, Sapporo Hanazono Hospital, Sapporo, Japan.

Abstract

Biphenotypic acute leukemias (BAL) account for less than 4% of all cases of acute leukemia. Philadelphia chromosome and 11q23 rearrangement are the most frequently found cytogenetic abnormalities. Since t(15;17) is almost always associated with acute promyelocytic leukemia, t(15;17) in BAL cases is extremely uncommon. We report here a rare and instructive case of BAL with t(15;17) and the successful treatment approach adopted. A 55-year old woman was referred to our hospital for an examination of elevated white blood cell (WBC) counts with blasts (WBC 13.4×109/L; 76% blasts). The blasts with acute lymphoblastic leukemia (ALL-L2, FAB) morphology coexpressed B-lymphoid and myeloid lineages, and a cytogenetic study revealed 4q21 abnormalities and t(15;17). However, promyelocytic-retinoid acid receptor α rearrangement was not detected by fluorescence in situ hybridization on interphase nuclei. Our patient was treated with chemotherapy for ALL and gemtuzumab ozogamicin without all-trans-retinoic acid, and has remained in hematologic first complete remission for more than 3.7 years.

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Published
2013-12-04
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Issue
Section
Case Reports
Keywords:
biphenotypic acute leukemias, t(15, 17), PML/RARα rearrangement, chemotherapy for acute lymphoblastic leukemia, gemtuzumab ozogamicin
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How to Cite
Saito, M., Izumiyama, K., Mori, A., Irie, T., Tanaka, M., Morioka, M., & Musashi, M. (2013). Biphenotypic acute leukemia with t(15;17) lacking promyelocytic-retinoid acid receptor α rearrangement. Hematology Reports, 5(4), e16. https://doi.org/10.4081/hr.2013.e16