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Case Reports
. 2016 Jun;63(6):1113-5.
doi: 10.1002/pbc.25953. Epub 2016 Feb 23.

Lineage Switch in MLL-Rearranged Infant Leukemia Following CD19-Directed Therapy

Ahmad Rayes  1 , Richard L McMasters  2 , Maureen M O'Brien  1
Affiliations
Case Reports

Lineage Switch in MLL-Rearranged Infant Leukemia Following CD19-Directed Therapy

Ahmad Rayes et al. Pediatr Blood Cancer. 2016 Jun.

Abstract

Rearrangements of the mixed lineage leukemia (MLL) gene occur frequently in infants with both acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Conversions of leukemia cell lineage are rare, but occur most commonly in the setting of MLL-rearrangement. Blinatumomab is a bidirectional antibody targeting CD19 with significant activity in relapsed B-precursor ALL. We report an infant with ALL with t(4;11)(q21;q23) refractory to cytotoxic chemotherapy who was treated with blinatumomab. Following rapid initial clearance of peripheral lymphoblasts, bone marrow evaluation demonstrated a leukemic lineage switch to CD19-negative monoblastic AML. Complete remission was achieved with myeloid-directed chemotherapy.

Keywords: CD19; MLL; blinatumomab; infant; leukemia; lineage.

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