Acute myeloid leukaemia with maturation demonstrates persistent disease with prominent megakaryoblastic differentiation 16 days following induction chemotherapy: an intra‐myeloid lineage switch mediated by chemotherapy‐induced clonal selection
Abstract
Lineage switch is infrequent in acute leukaemia with the literature limited to case reports or small series (Sakaki et al., 2009; Park et al., 2011; Rossi et al., 2012; Della Starza et al., 2016; Rayes et al., 2016; Wu et al., 2017; Hanley et al., 2018; Nomani et al., 2019). The majority of reported cases are switching between B cell acute lymphoblastic leukaemia (B-ALL) and acute myeloid leukaemia (AML) (Sakaki et al., 2009; Park et al., 2011; Rossi et al., 2012; Della Starza et al., 2016; Rayes et al., 2016) involving lysine methyltransferase 2A (KMT2A) re-arrangements in paediatric patients (Sakaki et al., 2009; Park et al., 2011; Rossi et al., 2012; Rayes et al., 2016). AML switching to other lineages is extremely uncommon, but has been reported in rare cases (Hanley et al., 2018; Nomani et al., 2019). AML with granulocytic differentiation switching to a megakaryoblastic phenotype has never been described in the English literature. Herein, we report an unusual case of AML with maturation (AML-M2 by French-AmericanBritish [FAB] classification) that converted to acute megakaryoblastic leukaemia (AML-M7 by FAB) by morphology and immunophenotypic profile during induction chemotherapy. The patient is a 62-year-old male who presented with anaemia, thrombocytopenia and marked leucocytosis (179 9 10/l), with markedly increased circulating blasts (64%). Subsequent bone marrow biopsy (biopsy 1) showed 67% blasts (Fig 1, upper panel A–C) that were positive for myeloperoxidase,…
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