We describe a unique B/T/myeloid MPAL case with MLL-AF4 gene rearrangement that was successfully treated with an AML-oriented strategy after pre-phase steroid therapy failed to remove leukemic blasts. MPAL is diagnosed by combining the expression of lymphoid (B- or T-cell) and myeloid markers, which may reveal a B/T lymphoid, B/myeloid, T/myeloid, or even a trilineage B/T/myeloid commitment. Pancytopenia, several bluish-purple skin lesions, gingival bleeding, fever, and night sweats were among the symptoms that landed a 34-year-old Palestinian social worker in Augusta Victoria Hospital in September 2018. Two weeks later, the patient was readmitted for consolidation chemotherapy with 3000 mg/m2 high dosage cytarabine (HIDAC) on days 1, 3, and 5. ALL-oriented chemotherapy has been shown to be more effective, and steroid response may indicate the need to transition to an AML-based strategy.
Author(S) Details
Noran Qawasmeh
College of Medicine, Al-Quads University, Abu-Dies, Palestine.
Mohammed Abu-Rayyan
Hematology Department and Bone Marrow Transplant Unit, Cancer Care Center, Augusta Victoria Hospital, East Jerusalem, Israel.
Mamdouh Skafi
Hematology Department and Bone Marrow Transplant Unit, Cancer Care Center, Augusta Victoria Hospital, East Jerusalem, Israel.
Moien Atrash
Hematology Department and Bone Marrow Transplant Unit, Cancer Care Center, Augusta Victoria Hospital, East Jerusalem, Israel.
Ibrahim Yaghmour
Laboratory Department, Augusta Victoria Hospital, East Jerusalem, Israel.
Ahlam Mujahed
Laboratory Department, Augusta Victoria Hospital, East Jerusalem, Israel.
Hamdi Al-Janazreh
Hematology Department and Bone Marrow Transplant Unit, Cancer Care Center, Augusta Victoria Hospital, East Jerusalem, Israel.
Fortunato Morabito
Hematology Department and Bone Marrow Transplant Unit, Cancer Care Center, Augusta Victoria Hospital, East Jerusalem, Israel and Biotechnology Research Unit, Aprigliano, Cosenza, Italy.
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