Abstract
Lymphoblasts of acute lymphoblastic leukemia origin reappeared in a male patient 34 years after the initial diagnosis. Comparison of DNA profiles of the initial and reappeared lymphoblasts revealed a partially identical sequence, indicating the possibility that these lymphoblasts may have been present as preleukemic stem cells at the time of diagnosis and remained dormant for a long period until additional events conferred proliferative activity to these dormant preleukemic stem cells. Thus, in some cases of very late relapse, the reappearance of lymphoblasts may not be due to the relapse of the original leukemic clone, but to a clonal progression of a pre-existing subclone derived from preleukemic stem cells.
References
Chessells JM, Hardisty RM, Richards S. Long survival in childhood lymphoblastic leukaemia. Br J Cancer. 1987;55:315–9.
Pui CH, Relling MV, Downing JR. Acute lymphoblastic leukemia. N Engl J Med. 2004;350:1535–48.
Feldman F, Tan CV. Acute leukemia-relapse after prolonged remission. J Pediatr. 1970;76:926–7.
Carcassonne Y. Relapse after presumed cure of childhood lymphoblastic leukaemia. Lancet. 1981;2(8224):473.
Levasseur M, Maung ZT, Jackson GH, et al. Relapse of acute lymphoblastic leukaemia 14 years after presentation: use of molecular techniques to confirm true re-emergence. Br J Haematol. 1994;87:437–8.
Frost L, Goodeve A, Wilson G, et al. Clonal stability in late-relapsing childhood lymphoblastic leukaemia. Br J Haematol. 1997;98:992–4.
Geetha N, Lali VS, Nileena N, Nair MK. Late recurrence of childhood acute lymphoblastic leukemia. Am J Clin Oncol. 1999;22:191–2.
Chow CD, Dalla-Pozza L, Gottlieb DJ, Hertzberg MS. Two cases of very late relapsing ALL carrying the TELÄML1 fusion gene. Leukemia. 1999;13:1893–4.
Vora A, Frost L, Goodeve A, et al. Late relapsing childhood lymphoblastic leukemia. Blood. 1998;92:2334–7.
van der Velden VH, Cazzaniga G, Schrauder A, et al. European Study Group on MRD detection in ALL (ESG-MRD-ALL): analysis of minimal residual disease by Ig/TCR gene rearrangements: guidelines for interpretation of real-time quantitative PCR data. Leukemia. 2007;21:604–11.
Wan JH, Trainor KJ, Brisco MJ, Morley AA. Monoclonality in B cell lymphoma detected in paraffin wax embedded sections using the polymerase chain reaction. J Clin Pathol. 1990;43:888–90.
Nygaard R, Moe PJ, Brincker H, et al. Late relapses after treatment for acute lymphoblastic leukemia in childhood: a population-based study from the Nordic countries. Med Pediatr Oncol. 1989;17:45–7.
Ford AM, Fasching K, Panzer-Grumayer ER, et al. Origins of “late” relapse in childhood acute lymphoblastic leukemia with TEL-AML1 fusion genes. Blood. 2001;98:558–64.
Wiemels JI, Ford AM, Van Wering ER, et al. Protracted and variable latency of acute lymphoblastic leukemia after TEL-AML1 gene fusion in utero. Blood. 1999;94:1057–62.
Hong D, Gupta R, Ancliff P, et al. Initiating and cancer-propagating cells in TEL-AML1-associated childhood leukemia. Science. 2008;319:336–9.
le Viseur C, Hotfilder M, Bomken S, et al. In childhood acute lymphoblastic leukemia, blasts at different stages of immunophenotypic maturation have stem cell properties. Cancer Cell. 2008;14:47–58.
Freyer DR, Devidas M, La M, et al. Postrelapse survival in childhood acute lymphoblastic leukemia is independent of initial treatment intensity: a report from the Children’s Oncology Group. Blood. 2011;117:3010–5.
Gandemer V, Chevret S, Petit A, et al. Excellent prognosis of late relapses of ETV6/RUNX1-positive childhood acute lymphoblastic leukemia: lessons from the FRALLE 93 protocol. Haematologica. 2012;97:1743–50.
Ko RH, Ji L, Barnette P, et al. Outcome of patients treated for relapsed or refractory acute lymphoblastic leukemia: a Therapeutic Advances in Childhood Leukemia Consortium study. J Clin Oncol. 2010;28:648–54.
Mullighan CG, Phillips LA, Su X, et al. Genomic analysis of the clonal origins of relapsed acute lymphoblastic leukemia. Science. 2008;322:1377–80.
Acknowledgments
We appreciate Prof. Mel Greaves for his valuable suggestions.
Conflict of interest
Any of authors, Fumio Bessho, Nobuyuki Takayama, Eva Fronkova and Jan Zuna, have nothing that should be disclosed.
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Bessho, F., Takayama, N., Fronkova, E. et al. Reappearance of acute lymphoblastic leukemia 34 years after initial diagnosis: a case report and study of the origin of the reappeared blasts. Int J Hematol 97, 525–528 (2013). https://doi.org/10.1007/s12185-013-1289-9
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DOI: https://doi.org/10.1007/s12185-013-1289-9