A Case of Acute Lymphoblastic Leukemia with Maturation

Jeong-Hun Kim; Woo-In Lee; Su-Yon Park; Hwi-Joong Yoon; So-Young Kang; Jin-Tae Suh

doi:10.5045/kjh.2006.41.1.46

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Kim, Lee, Park, Yoon, Kang, and Suh: A Case of Acute Lymphoblastic Leukemia with Maturation

Case Report

Korean J Hematol 2006;41(1):46-50.

Published online: 19 March 2006

DOI: https://doi.org/10.5045/kjh.2006.41.1.46

A Case of Acute Lymphoblastic Leukemia with Maturation

Jeong-Hun Kim, M.D.¹, Woo-In Lee, M.D.^1,, Su-Yon Park, M.D.¹, Hwi-Joong Yoon, M.D.², So-Young Kang, M.D.¹, Jin-Tae Suh, M.D.¹

¹Departments of Laboratory Medicine, Seoul, Korea

²Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Korea

Correspondence to：Woo-In Lee, M.D. Department of Laboratory Medicine, College of Medicine, Kyung Hee University 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-702, Korea Tel: +82-2-958-8673, Fax: +82-2-958-8609 E-mail: wileemd@khu.ac.kr

Received 22 December 2006 Revised 9 February 2006 Accepted 5 March 2006

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Acute lymphoblastic leukemia with maturation (ALLm) has different disease characteristics that does typical ALL. ALLm is characterized by an increased number of mature appearing leukemic cells (>20% of ANCs in the BM) having differentiation beyond the prolymphocyte stage according to light microscopic (LM) examination. It also has a worse prognosis than typical ALL. We have recently experienced a case of ALLm and we report on this case along with a literature review. A 36 year old patient showed lymphoblasts and mature appearing leukemic cells that were counted up to 15.8% and 23.0%, respectively, of the WBCs on bone marrow examination. Despite their mature appearance, these cells showed positivity for Tdt, CD10, CD19 and HLA-DR on the immunophenotypic study. Differentiating the mature-appearing leukemic cells from the hematogones or mature lymphocytes is difficult, and only through immuno-phenotypic examination is it possible to discriminate ALLm from typical ALL. We suggest performing a leukemic marker study that includes CD38 to effectively differentiate mature appearing leukemic cells from hematogones, especially for the follow up of leukemia with mature appearing cells.

Keywords: ALLm, Tdt, CD10, CD19, CD38 and HLA-DR

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Fig. 1

Bone marrow aspiration & biopsy section smear. Positive finding displaying dot or coarse granular pattern (Periodic acid-Schiff stain, ×1,000).

Fig. 2

Bone marrow aspirate smears at time of first relapse demonstrate numerous mature appearing leukemic cells (Wright stain, ×1,000).

Table 1.

Progression of patient course according to results of bone marrow study

Days∗	Bone marrow study	Cell count		Immunophenotypic study^†
Days∗	Bone marrow study	Lymphoblasts	Mature appearing leukemic cells	Immunophenotypic study^†
1	ALL L1	78.2%	0%	HLA-DR: 90%
				CD10: 80%
				CD19: 90%
32	Persistence	7.2%	0%	ND
71	Relapse	15.8%	23.0%	HLA-DR: 95.1%
				Tdt: 21.0%
				CD10: 93.9%
				CD19: 89.5%
108	Remission	2.0%	0%	HLA-DR: 24.0%
				Tdt: 55.2%
				CD10: 0.3%
				CD19: 0.1%
166	Relapse	39.8%	16.2%	HLA-DR: 86.6%
				Tdt: 78.5%
				CD10: 82.3%
				CD19: 62.3%
				CD45: 8.3%
				CD22: 6.6%
				CD38: 0.4%
				CD34: 78.2%
				CD20: 56.4%

^∗ Based on time of first diagnosis,

^† Positivity defined as antigen expression by 20% or more leukemic cells, except for Tdt positivity, defined as expression by 10% or more. Abbreviations: FISH, fluorescent in situ hybridization; ND, not done; Tdt, terminal deoxynucleotidyl transferase.

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