Date: 07 May 2014

Different clones of acute leukemia after successful treatment of Hodgkin’s disease

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Dear Editor,

Here, we report the rare manifestation of therapy-related T-cell acute lymphoblastic leukemia (T-ALL) harboring an activating FLT3 length mutation (FLT3-LM) following curative therapy of Hodgkin’s disease. After successful treatment of T-ALL including achievement of molecular remission, the patient relapsed while bone marrow blasts could now be characterized as therapy-related acute myeloid leukemia without FLT3-LM.

In December 2011, a 68-year-old woman was admitted with leukocytosis (171/nl) and 71 % blasts in the differential (Fig. 1a). The patient suffered from dyspnea not only due to high blast count but also as a result of a non-ST-elevation myocardial infarction as a sign of leukostasis. After immediate exclusion of coronary heart disease, a dual emergency strategy consisting of leukapheresis and chemotherapy with cytarabine (AraC) was commenced.Fig. 1

Presentation of acute leukemia at initial diagnosis (left) and at relapse (right). Blood smear demonstrating leukemic b ...