Table 1 Summary of the cases and pathologic features of B-cell acute lymphoblastic lymphoma following immunomodulatory imide treatment of plasma cell myeloma
PatientRef, Yearb (agea, sex) | PCM tx (mo on tx) | B-ALL Presentation | B-ALL Molecular Profile | B-ALL Cytogenetics | B-ALL treatment | Response/Duration |
|---|---|---|---|---|---|---|
Index pt., 2019 (82, Male) | VAD (3) Mel/dex (5) Thal/dex (36) Len/dex (15) Len (31) | Increasing M protein (0.4 g/dL) HCT (32%) WBC count (0.8 × 109 cells/L) Platelet count (89 × 109 cells/L) | Marrow: 60% lymphoblasts +: CD34, 138, TdT Mixed: CD10, 45, HLA-DR -: CD20, 38, Ph | Trisomy 8 + 21 | DVd | PR (15+ mo) |
Pt 1 [18], 2018 (53, Female) | RT VD (NS) AHSCT Len (72) | Leukopenia Thrombocytopenia | Marrow: 50% lymphoblasts +: CD19, 34, 38, 79a, PAX5, TdT | Trisomy 8 + 10 + 21 Copy gain MYC, IgH Monosomy 2 | CALGB 8811 POMP maintenance | CR (12+ mo) |
Pt 2 [18], 2018 (69, Female) | Bortezo/len/dex (NS) ASHCT Len (23) | M protein spike (0.5 g/dL) | Marrow: 25% lymphoblasts +: CD19, 22, 34 -: Ph | 46, XX, t(7;19) | Hyper-CVAD POMP maintenance | CR (36+ mo) |
Pt 3 [29], 2017 (59, Male) | Bortezo/len/dex (5) AHSCT Mel (NS) Len (30) | Fatigue Neutropenia Thrombocytopenia | Marrow: 20% lymphoblasts +: CD10, 19 Mixed: CD20, 79a, PAX5, TdT -: Ph | Deletion 20q | Linker regimen Flu/mel/allo-SCT | CR (12+ mo) |
Pt 4 [29], 2017 (34, Male) | Dex (1) Thal/dex (36) Len (36) | Pancytopenia Circulating lymphoblasts | Marrow: near 100% lymphoblasts +: CD10, 19, 22, 34, 38, 79a | Chr 14 rearrangement | CALGB 8811 | Died during induction |
Pt 5 [29], 2017 (53, Male) | RT Bortezo/len/dex (12) Mel/AHSCT Len (84) | Leukopenia Neutropenia | Marrow: 20–30% lymphoblasts +: CD19, 34, 79a, PAX5, TdT -: Ph | Tetraploidy | Linker regimen AHSCT/BEAM | CR (12+ mo) |
Pt 6 [28], 2016 (66, Male) | VD (2) Len (2) VADM (2) Thal (31) | WBC count (3.05 × 109 cells/L) No monoclonal band on SPEP | Marrow: 62% lymphoblasts +: CD19, 22, 34, 45, TdT Mixed: CD79a | Trisomy 4 | CHOP | Died during induction |
Pt 7 [31], 2016 (65, Female) | VADM (2) Len (2) VD (2) Thal (33) | Dizziness | Marrow: 68% lymphoblasts +: CD19, 22, 34, 45, 79a, HLA-DR -: CD20, 54, 38, 138, Ph | NS | No treatment | Died |
Pt 8 [31], 2016 (63, Male) | PAD (4) AHSCT RT VTD (1) Thal (32) | Fatigue Platelet count (33 × 109 cells/L) No monoclonal band on SPEP | Marrow: 84% lymphoblasts +: CD10, 34, HLA-DR -: CD20, 38, 138 | NS | Lost to follow-up after diagnosis | |
Pt 9 [31], 2016 (33, Female) | DVd (1) VD (4) AHSCT Thal (73) | Cough Fatigue Hgb (10.9 g/dL) No monoclonal band on SPEP | Marrow: 84% lymphoblasts +: CD10, 19, 22, 34, 79a, HLA-DR -: CD20, 25 | NS | No treatment | Lost to follow-up |
Pt 10 [27], 2013 (62, Female) | VD (4) High-dose dex (2) VBMCP/VBAD (5) Len/dex (3) AHSCT Len (20) | Fatigue Pancytopenia | +: Ph, CD10, 19, 20, 22, 79a, TdT -: CD34 | 46, XX | NS | Died during induction |
Pt 11 [33], 2013 (72, Male) | VAD (4) RT Len/dex (36) | Pancytopenia No evidence of active MM | Marrow: 66% lymphoblasts +: CD10, 19, 20, 79a, TdT -: CD34, 38 | NS | Hyper-CVAD POMP maintenance | CR (12 mo) then relapse |
Pts 12–14 [36], 2012 (NS, NS) | AHSCT Len (NS) | NS | NS | NS | NS | NS |
Pt 15 [26], 2012 (NS, NS) | AHSCT Len (NS) | NS | NS | NS | NS | NS |
Pt 16 [30], 2012 (61, Female) | VCMP (7) VMAP (4) Thal (29) | Pancytopenia No monoclonal band on SPEP | Marrow: 93% lymphoblasts +: CD19, 38 -: CD10, 20, 23, 138 | 46, XX | CALGB 9911 Relapse: VP | CR (10 mo) then relapse Relapse: CR (12+ mo) |
Pt 17 [32], 2012 (56, Female) | VCMP (7) Mel/thal/dex (16) Thal (53) | Edema Dyspnea WBC count (3.077 × 109 cells/L) Hgb (8.6 g/dL) Platelet count (80 × 109 cells/L) | Marrow: 37.8% lymphoblasts +: CD10, 19, 20, 22, HLA-DR -: Ph | 46, XX | Steroids | Died |