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Related Experiment Video

Updated: Dec 10, 2025

Tumor Engraftment in a Xenograft Mouse Model of Human Mantle Cell Lymphoma
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Lenalidomide-Associated Secondary B-Lymphoblastic Leukemia/Lymphoma-A Unique Entity.

Sharon Koorse Germans1, Ozlem Kulak1, Prasad Koduru2

  • 1Department of Pathology, University of Texas Southwestern Medical Center, Dallas.

American Journal of Clinical Pathology
|September 4, 2020
PubMed
Summary

Lenalidomide maintenance after stem cell transplant for multiple myeloma can lead to secondary B-lymphoblastic leukemia/lymphoma (B-ALL). Early B-ALL detection requires careful evaluation due to subtle presentation, with relapse indicating complex genetic changes.

Keywords:
B-lymphoblastic leukemiaLenalidomideMultiple myeloma

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Area of Science:

  • Hematology
  • Oncology
  • Immunology

Background:

  • Autologous stem cell transplant (ASCT) with lenalidomide maintenance improves outcomes for multiple myeloma (MM).
  • ASCT with lenalidomide is associated with an increased risk of secondary B-lymphoblastic leukemia/lymphoma (B-ALL).

Observation:

  • This review details the clinicopathologic features of two patients who developed secondary B-ALL during lenalidomide maintenance therapy for MM.
  • Secondary B-ALL presented with subtle clinical, morphologic, and flow-cytometric findings, potentially mimicking hematogones.

Findings:

  • Both patients achieved complete remission with chemotherapy, but one has minimal residual disease and the other relapsed.
  • Next-generation sequencing of the relapse specimen revealed complex genetic abnormalities, suggesting clonal evolution.

Implications:

  • Increased awareness of secondary B-ALL in MM patients on lenalidomide maintenance is crucial.
  • Further research is needed to understand and manage this complication effectively.