Hybrid leukaemia of T cell and myeloid lineages: cytogenetic distinction from second (induced) malignancy

The therapeutic and prognostic implications of relapse and clonal evolution of leukaemia are substantially different from those of secondary (induced) malignancy. This report documents the case of a patient who presented with apparent acute non-lymphocytic leukaemia (ANLL) following therapy for acute (T-cell) lymphoblastic leukaemia (ALL) 4 years previously. Morphologically and cytochemically the cells were of myeloid type, but the cell markers showed a T cell lineage. Cytogenetic studies confirmed that this was a relapse of T cell ALL with a phenotypic change, rather than a second malignancy induced by chemotherapy. A 14q deletion present at initial diagnosis recurred at relapse, with the addition of cells with complete deletion of chromosome 14, indicating clonal evolution.