Lineage switch under blinatumomab treatment of relapsed common acute lymphoblastic leukemia without MLL rearrangement

Pediatr Blood Cancer. 2017 Nov;64(11). doi: 10.1002/pbc.26594. Epub 2017 Apr 28.

Abstract

Blinatumomab is a bispecific T-cell engaging αCD19 antibody used in refractory or relapsed B-cell precursor acute lymphoblastic leukemia (ALL). Recently, lineage switch to a myeloid phenotype has been described following CD19 targeting treatment in three pediatric patients with mixed lineage leukemia (MLL) rearranged ALL. We report the case of a female who received blinatumomab for a first relapse of ALL without MLL alterations. She suffered from a second relapse early after hematopoietic stem cell transplantation and was treated with blinatumomab again. During this treatment, the leukemia lost CD19 expression as well as nearly all other B-cell markers, while still harboring the initial minimal residual disease marker, and switched to a myeloid phenotype.

Keywords: ALL; MLL; blinatumomab; lineage switch.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Bispecific / adverse effects*
  • Antigens, CD19 / metabolism*
  • Antineoplastic Agents / adverse effects
  • Cell Lineage*
  • Child
  • Female
  • Gene Rearrangement
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Histone-Lysine N-Methyltransferase / genetics
  • Humans
  • Leukemia, Myeloid, Acute / chemically induced*
  • Leukemia, Myeloid, Acute / genetics
  • Leukemia, Myeloid, Acute / metabolism
  • Leukemia, Myeloid, Acute / pathology
  • Myeloid-Lymphoid Leukemia Protein / genetics
  • Neoplasm Recurrence, Local / drug therapy*
  • Neoplasm Recurrence, Local / epidemiology
  • Neoplasm, Residual / drug therapy
  • Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / therapy
  • Prognosis

Substances

  • Antibodies, Bispecific
  • Antigens, CD19
  • Antineoplastic Agents
  • KMT2A protein, human
  • Myeloid-Lymphoid Leukemia Protein
  • blinatumomab
  • Histone-Lysine N-Methyltransferase