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T-Cell therapy–related acute lymphoblastic leukaemia: case report A 5-year-old boy developed T-Cell therapy–related acute lymphoblastic leukaemia following treatment with dasatinib, daunorubicin and etoposide for B-cell acute lymphoblastic leukaemia [routes, outcome and not all dosages stated]. The boy presented with progressively worsening tachypnea and cough. Three years before, he was diagnosed with B-cell acute lymphoblastic leukaemia and received chemotherapy with daunorubicin 255 mg/m2, etoposide 4000 mg/m2 and dasatinib. Later, he achieved complete remission. At that time, there were no rearrangement of KMT2A was observed on lab tests. At the current presentation, his chest x-ray and CT scan showed 4cm anterior mediastinal mass. Also, he had thrombocytopenia and leukocytosis. His biopsy of peripheral blood smear and bone marrow revealed frequent blasts with ovoid to convoluted nuclei some of which had moderate amounts of basophilic cytoplasm with vacuoles. Subsequently, his cytometric immunophenotypic analysis showed the blasts were bright CD45+, cytoplasmic CD3+, CD2+, CD5+, CD7+, CD8+, dimCD4+, bright CD1a+, and negative for all B-cell antigens. The Tdt was consistent with T-lymphoblasts. His T-cell receptor gamma chain gene rearrangement studies demonstrate a clonal pattern. Therefore, he was diagnosed with T-cell acute lymphoblastic leukaemia [durations of treatments to reactions onset not stated]. Later, the boy received chemotherapy with four-drug induction and achieved bone marrow MRD level of 0.15%. Thereafter, he received two cycles of nelarabine chemotherapy, followed by allogeneic stem cell transplant from an unrelated donor for curative intent. However, six months later, mediastinal mass recurred. Therefore, he continued chemotherapy. Eventually, he died [immediate cause of death not stated]. Mariani RA, et al. Inv(11)(q21q23); KMT2A-MAML2, a Recurrent Genetic Abnormality in T-Cell Therapy-related Acute Lymphoblastic Leukemia. Journal of Pediatric 803519440 Hematology/Oncology 42: e258-e261, No. 4, May 2020. Available from: URL: http://doi.org/10.1097/MPH.0000000000001572

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