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Case Reports
. 2023 Jun 19;15(6):e40661.
doi: 10.7759/cureus.40661. eCollection 2023 Jun.

Treatment of Relapsed B/T-cell Mixed Phenotype Acute Leukemia With Blinatumomab

Yasmeen Abdo  1 , Geoffrey D Gibson  2 , Sarika P Jain  3 , Carter P Milner  2 , Talal Hilal  2   4
Affiliations
Case Reports

Treatment of Relapsed B/T-cell Mixed Phenotype Acute Leukemia With Blinatumomab

Yasmeen Abdo et al. Cureus. .

Abstract

Here, we describe the treatment of a patient with relapsed/refractory B/T mixed phenotype acute leukemia (MPAL) using blinatumomab monotherapy, the first bispecific T cell engager (BiTE) approved by the FDA for relapsed/refractory B cell acute lymphoblastic leukemia (B-ALL). A 64-year-old man with a history of stage 3 chronic kidney disease and type 2 diabetes mellitus was discovered to have B/T MPAL on bone marrow biopsy during hospitalization for dyspnea due to pulmonary embolism. The patient achieved brief remission with blinatumomab treatment before succumbing to neutropenic sepsis. The lack of sufficient data to guide therapy in MPAL remains a challenge, highlighting the potential of new targeted approaches such as blinatumomab to improve outcomes in relapsed/refractory MPAL.

Keywords: b/t mixed acute leukemia; bispecific t cell engager; blinatumomab; clinical hematology; mixed phenotype acute leukemia.

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Conflict of interest statement

The authors have declared financial relationships, which are detailed in the next section.

Figures

Figure 1
Figure 1. Bone marrow aspiration
(A) Bone marrow aspirate shows blasts that are variable in size with a high nucleus-to-cytoplasmic ratio, dispersed nuclear chromatin, and prominent nucleoli (Wright’s, 100X), and (B) bone marrow biopsy shows sheets of lymphoid blasts (H&E, 1000X)
Figure 2
Figure 2. Flow cytometry
Flow cytometry plot shows the blast population (blue color) post for CD34 expressing (A) CD19, (B) CD10, and (C) cytoplasmic CD3 consistent with B/T-lymphoid mixed phenotype acute leukemia
See this image and copyright information in PMC

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