LINEAGE SWITCH LEUKEMIA LIMFOBLASTIK AKUT MENJADI LEUKEMIA MIELOMONOSITIK AKUT PADA PEREMPUAN USIA 26 TAHUN (Lineage Switch From Acute Lymphoblastic Leukemia To Acute Myelomonocytic Leukemia at A 26 Years Old Woman)

Abstract

A lineage switch from Acute Lymphoblastic Leukemia (ALL) to Acute Myeloid Leukemia (AML) is very rare. It was estimated between
6− 9% of cases that occurred, especially lineage switch from ALL to Acute Myelomonoblastic Leukemia (AMMOL). The reviewers report
a case of a 26 years old women with the first clinical presentation were fever and double visions and diagnosed as B-Acute lymphoblastic
leukemia ALL with CD13 and CD33 expression aberrations, based on Bone Marrow Aspiration (BMA) and immunoprephenotyping in
Hongkong Hospital. After induction therapy, in the second month, BMA was done and found 10% blast, so it couldn't be assessed as
complete remission. After two (2) months, she comes back to Indonesia to follow continuing the treatment. She was suffered from severe
headache and blurred vision. The blast cell morphology of BMA showed myeloblast 25% and monoblast 60%, consistent with the diagnosis
of AMMOL. Moreover, both findings were quite specific for each common cell ALL and acute myelomonocytic leukemia. These findings
support that this case is completely different leukemic clones occurred at each leukemic expression. Exogenic factor such as chemotherapy
and endogenic factor due to chromosomal abnormalities is supposed to be the cause of this lineage switch during the treatment.