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A 55 year old woman was admitted to the emergency room with progressive fatigue and fever. Her physical examination revealed fever (38.8°C), pallor, ecchimoses in the lower extremities. Abnormal laboratory values included: hemoglobin: 7.7gr/dl, hematocrit: 23%, white blood cell: 33 600/μl, platelets: 20 400/μl, lactic dehydrogenase: 2632 IU. Lymphoblasts were found in the peripheral blood smear and bone marrow aspiration revealed a hypercelluler bone marrow with diffuse blast cell infiltration. Flow cytometric analysis was positive for TdT, CD 10, CD19, CD10, D19, CD20, CD22, CD24, CD34, cyCD79a, HLADR and surface IgM (mu) with negative kappa and lambda. Cytogenetic analysis of the bone marrow performed with GTG-banding with short term unstimulated culture showed a karyotype; 46,XX,t(9,22)(q34;q11) [2]/40-44,XX[2]/46,XX [1]. Bcrabl was positive by RT-PCR. She was diagnosed with Philadelphia chromosome positive transitional pre-B acute lymphoblastic leukemia (ALL) and Hyper CVAD (hyperfractionated cyclophosphamide, vincristin, adriamycine and dexamethasone) chemotherapy and tyrosine kinase inhibitor (imatinib) was commenced. Patient succumbed to sepsis seven days after starting chemotherapy.

clinical case reports and reviews.

Lymphoblasts expressing surface IgM in the absence of kappa and lambda in Philadelphia positive acute lymphoblastic leukemia: Philadelphia chromosome positive transitional pre-B acute lymphoblastic leukemia