Figure 1

BoardVitals

Clinical Scenario

How would you manage this patient?

A 27-year-old female, G2P1001, who is in the second trimester of her current pregnancy, presents to the emergency department with complaints of fever, fatigue, and chin numbness which has been present for the last week without any changes. On examination, the numbness in the chin is confirmed. In addition, she is found to have hepatosplenomegaly. Laboratory testing is ordered, and before results are obtained, the laboratory calls to report the presence of blasts in the peripheral smear. Oncology is consulted, and flow cytometry is performed, which is significant for precursor B-cell Acute Lymphoblastic Leukemia (Pre-B-ALL), based on the strong expression of CD19, CD22, CD79a, TdT, HLA-DR, and cytoplasmic IgM, and negativity for CD20 in a population of cells consistent with blasts. A rush cytogenetics workup is positive for [t(9;22)] (Ph). Systemic therapy is to be initiated. Which of the following would be appropriate for the management of Pre-B-ALL during the second trimester of pregnancy?