4.5 Article

Characterization of myelodysplastic syndromes progressing to acute lymphoblastic leukemia

Journal

ANNALS OF HEMATOLOGY
Volume 100, Issue 1, Pages 63-78

Publisher

SPRINGER
DOI: 10.1007/s00277-020-04114-2

Keywords

Myelodysplastic syndrome; Acute lymphoblastic leukemia; Acute myeloid leukemia; Phenotype switch; Leukemic stem cell; Hematopoietic stem cell; Early progenitor; Mixed lineage leukemia; MLL; KTM2A

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Funding

  1. Personalized Health and Related Technologies (PHRT) strategic focus area of the Swiss Federal Institutes of Technology (ETH) Domain
  2. Swiss Personalized Health Network (SPHN) initiative of the Swiss Academy of Medical Sciences [2017-407]

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Myelodysplastic syndromes (MDS) have a variable probability of transforming into acute leukemia, with rare cases of acute lymphoblastic leukemia reported in MDS patients. These atypical cases highlight the possibility of major phenotypic switches occurring during disease progression.
Myelodysplastic syndromes (MDS) are a heterogeneous group of diseases, with a variable probability of transformation into acute leukemia, which is, in the vast majority of cases, of myeloid lineage. Nevertheless, rare cases of acute lymphoblastic leukemia in patients with previously diagnosed MDS have been reported. We describe a series of 3 cases of MDS/CMML marked with evolution to acute lymphoblastic leukemia (ALL) and provide a comprehensive review of the 49 cases documented in the literature so far. These sporadic events have only been published as single-case reports or small series to date. Such atypical cases emphasize the possibility of major phenotypic switches arising at the leukemic stem cell (LSC) and/or early progenitor levels, as a consequence of epigenetic and genomic events driving these changes in the bone marrow niche.

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