Adult acute lymphoblastic leukemia with near haploidy, hyperdiploidy and Ph positive lines: a rare entity with poor prognosis

Chromosomal ploidies provide a wealth of information with respect to the prognosis of patients with acute lymphoblastic leukemia (ALL). The prognosis is favourable in hyperdiploidy (450 ALL), whereas pseudodiploidy and hypodiploidy have an overall poor clinical outcome. Near haploid ALL with less than 30 chromosomes in the leukemic blasts has been reported. This is an extremely rare malignancy with an adverse clinical course compared to other lymphoblastic leukemias. We present a case of near haploid ALL in an adult male with a diagnosis of pre-B-cell ALL. The presenting features and relevance to the progression of disease are discussed with respect to the near haploid lines. Occurrence in an adult male and the presence of additional clones with structural abnormalities are both unique to the present study. Cautionmust be exercised when the hyperdiploidmetaphases consists exclusively of tetrasomic chromosomes and morphological examination reveals definite dual populations of large and small lymphoblasts. Despite current developments in ALL therapy, near haploid ALL continues to be a disease with an adverse clinical outcome and newer therapeutic strategies are warranted for better management of the disease.