05 August 2024
: Case report 
Long-Term Remission in T315I+ Relapsed Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia with Blinatumomab and Allogeneic Stem Cell Transplantation: Two Case Studies
Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Unexpected drug reaction, Rare disease, Clinical situation which can not be reproduced for ethical reasons
Ziyang Huang1CD, Yu Zhang1CD, Jingjing Chen1CD, Yifen Shi1CF, Peng Chen1CF, Songfu Jiang1AE, Honglan Qian12ACE*DOI: 10.12659/AJCR.944956
Am J Case Rep 2024; 25:e944956
Table 1. Baseline clinical characteristics.
| Sl No | Test | Patient 1 | Patient 2 | |
|---|---|---|---|---|
| 1 | Peripheral blood analysis | WBC | 141.80×10/L (high) | 93.63×10/L (high) |
| RBC | 4.7×10/L (normal) | 3.86×10/L (low) | ||
| Platelets | 81×10/L (low) | Platelets- 5×10/L (low) | ||
| HB | 14.30 g/dL (normal) | 10.7 g/dL (normal) | ||
| Blasts | 90% | 92% | ||
| 2 | Biochemistry | S. Urea | 4.0 mmol/L (normal) | 4.6 mmol/L (normal) |
| S. Uric acid | 527 umol/L (high) | 412 umol/L (normal) | ||
| S. Creatinine | 60 umol/L (normal) | 83 umol/L (normal) | ||
| S. Sodium | 142 mmol/L (normal) | S. Sodium- 137 mmol/L (normal) | ||
| S. Potassium | 3.36 mmol/L (low) | 4.47 mmol/L (normal) | ||
| S. Chlorides | 105 mmol/L (normal) | 101 mmol/L (normal) | ||
| S. Albumin | 3.70 g/dL (low) | 3.92 g/dL (low) | ||
| S. Protein | 6.68 g/dL (normal) | 7.25 g/dL (normal) | ||
| S. Alkaline Phosphatase- | 189 U/L (high) | 89 U/L (normal) | ||
| S. AST | 130 U/L (high) | 19 U/L (normal) | ||
| S. ALT | 124 U/L (high) | S. ALT 35 U/L (normal) | ||
| S. LDH | 2123 U/L (high) | 565 U/L (high) | ||
| S. Calcium | 2.34 mmol/L (normal) | 2.21 mmol/L (normal) | ||
| 3 | Microbiology | HBsAg, Anti HCV, HIV, CMV, EBV Antibodies- unreactive | HBsAg, Anti HCV, HIV, CMV, EBV Antibodies- unreactive | |
| 4 | Immunophenotype | CD19+, CD22+, CD34+, CD10+, HLA-DR +, CD33 int, CD117−, CD13 −, CD20 dim, CD11b−, CD56, CD7−, CD99+, CD66c +, CD58+, CD21 dim, CD23−, nTDT+, cCD79a+, cCD3−, CD56−, CD38 dim, cMPO− | CD19+, CD22+, CD34+, CD41−, CD10+, HLA-DR int, CD33 int, CD117−, CD13+, CD15−, CD20−, CD11b−, CD56− | |
| 5 | Cytogenetics | 46XY | 46XX, t (8; 9) (q13;p22), t(9;22) (q34;q11.2) | |
| 6 | Next-generation sequencing | Negative | Fusion of WT1 gene (variant allele frequency: 0.15%) | |
| 7 | Level of BCR-ABL p190 transcript | 46.29% | 35.29% | |
| 8 | PH-Like fusion gene | Negative | IKZF1 | |
| 9 | Post-induction MRD | 96% | 88.29% | |
| Anti HCV – hepatitis C antibody; CMV – cytomegalovirus; EBV – Epstein-Barr virus; HB – hemoglobin; HBsAg – hepatitis B surface antigen; HIV – human immunodeficiency virus; RBC – red blood cell; S.ALT – serum alanine transaminase; S.AST – serum aspartate aminotransferase; S.LDH – serum lactate dehydrogenase; WBC – white blood cell. | ||||