This is a case of acute B #Lymphoblastic-leukemia. Images 1 | Figure 1

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Case Summary

This is a case of acute B #Lymphoblastic-leukemia. Images 1 and 2 are of the bone marrow aspirate and show a large percentage of cells to be blasts (orange arrow). Images 3 and 4 are of the bone marrow core biopsy which is packed with sheets of leukemic cells. Image 5 shows flow cytometry data. Each dot represents a cell and red dots are blasts. Cell surface marker expression is determined by which quadrant the dots fall in. About 80% of cells in this marrow are blasts and they express CD10, CD19, some CD20, some CD33 and 34, and CD58. CD19 and CD20 expression defines the blasts as B lineage.

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Clinical Details

A 56-year-old female commences induction therapy with rituximab and hyper-CVAD chemotherapy for her Philadelphia chromosome-negative, CD20+ precursor B-cell acute lymphoblastic leukemia (ALL). Staging studies following her induction treatment, including bone marrow biopsy and laboratory analysis, reveal that she has attained a complete remission. However, PCR analysis reveals that she is minimal residual disease (MRD) positive (>0.1%). She has an outstanding performance status. Which of the following therapies would you recommend? This question is provided by HemeOncQuestions.

Another Case

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...
Which of the following would be appropriate for the management of Pre-B-ALL during the second trimester of pregnancy?

Phenotype Quiz

A 4-year-old girl presents to the emergency department with multiple bruises on her limbs and recent weight loss of 4 lb. Which one of the following statements regarding the phenotypic characteristics of acute leukemia is true?
A. CD19 expression is almost never observed in AML. B. Terminal deoxynucleotidyl transferase (TdT) can be positive in a subset of AMLs. C. It is not uncommon to see the absence of CD19 on B-cell lymphoblastic leukemias. D. If the lesional cells express CD13, they must be of the myeloid lineage. E. CD117 is commonly seen in ALL.
Question from PathPrimer.

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