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BACKGROUND: We present a case of focal lymphoblastic transformation to erythroid leukemia following acute myeloblastic transformation in a patient with chronic myelogenous leukemia (CML) and discuss its mechanism of occurrence and development. CASE SUMMARY: The presence of the Philadelphia (Ph) chromosome was identified through karyotype analysis, while the BCR-ABL fusion gene was detected using quantitative real-time polymerase chain reaction of the peripheral blood sample. Fluorescence in situ hybridization was used to detect the expression of the BCR-ABL gene in the lymphoma. Antigen expression and gene mutations in the primitive cells were detected by flow cytometry. The analysis confirmed the presence of CML along with focal lymphoblastic transformation to erythroid leukemia. Additionally, the patient was found to have secondary erythroid leukemia, along with multiple new gene mutations and abnormalities in complex karyotypes of chromosomes. CONCLUSION: Our findings suggest a possible molecular basis for the focal lymphoblastic transformation secondary to myeloblastic transformation in patients with CML.
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OBJECTIVE: To investigate the alteration and clinical significance of IFN-γ, IL-4, IL-17 and TGF-ß levels in serum of patients with chronic lymphocytic leukemia treated with FCR. METHODS: Forty-seven CLL patients treated with FCR regimen were enrolled in CLL group, meanwhile 30 healthy persons were selected in control group. The serum levels of IFN-γ, IL-4, IL-17 and TGF-ß were detected by ELISA in CLL group before and after treatment and in control group, then the differences of IFN-γ, IL-4, IL-17 and TGF-ß levels as well as IFN-γ/IL-4 ratio and TGF-ß/IL-17 ratio were compared between 2 groups. RESULTS: Before treatment with PCR regimen, the IL-4, IL-17 and TGF-ß levels as well as TGF-ß/IL-17 in CLL group were higher than those in control group (P<0.05), while the IFN-γ level and IFN-γ/IL-4 ratio in CLL group were lower than those in control group (P<0.05); after treatment with PCR regimen, the IL-4, IL-17 and TGF-ß levels as well as TGF-ß/IL-17 ratio all significantly decreased (P<0.05), while IFN-γ level and IFN-γ/IL-4 ratio significantly increased (P<0.05) as compared with those before treatment, moreover, the IL-4 and IL-17 levels as well as TGF-ß/ IL-17 and IFN-γ /IL-4 ratio were no significantly different from those in control group (P>0.05), only the IFN-γ and TGF-ß levels were significantly diffrent from control group (P<0.05). The analysis of Binet staging (stage A, B, C) showed that along with pregression of Binet stages, the TGF-γ/IL-17 levels as well as the IFN-γ/IL-4 ratio in CLL group negatively correlated with Binet staging (r=-0.53), while the TGF-ß/IL-17 ratio positively correlated with Binet staging (r=0.46). The analysis of grouping accoraing to therapentic efficacy fonnd that the IL-4 and IL-17 levels and IFN-γ/IL-4 and TGF-ß/IL-17 ratios in CR and PR groups were significantly different before and after treatment (P<0.05), while those in SD and PD groups did not showed statistical difference before and after treatment (P>0.05). CONCLUSION: Along with the progression of disease, the IFN-γ/ IL-4 ratio gradually decreases, and the TGF-ß / L-17 ratio gradually increases. The treatment with FCR regimen can overcome this tread, therefore dynamically monitoring the chages of IFN-γ/ IL-4 and TGF-ß / L-17 ratios may contribute to guide the clinical treatment.