Emergence of a Ph-negative Clone in a Child With Ph+ ALL

J Pediatr Hematol Oncol. 2020 Aug;42(6):e466-e468. doi: 10.1097/MPH.0000000000001521.

Abstract

The addition of tyrosine kinase inhibitors to conventional chemotherapy has improved outcomes for pediatric patients with Philadelphia chromosome-positive (Ph) acute lymphoblastic leukemia (ALL). However, the rate of relapse is still higher compared with many other types of pediatric ALL, with many possible mechanisms for resistance. We describe an 8-year-old boy with Ph ALL relapsing with ALL without the Ph following treatment with dasatinib as a part of Children's Oncology Group trial AALL1122. This emphasizes the polyclonal nature of ALL at diagnosis and indicates that the BCR-ABL fusion oncogene is not always an essential "driver" mutation.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Agents / therapeutic use
  • Child
  • Dasatinib / therapeutic use
  • Humans
  • Male
  • Philadelphia Chromosome*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / classification
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / genetics
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / pathology*
  • Prognosis

Substances

  • Antineoplastic Agents
  • Dasatinib