Rare Atypical Ela3 BCR-ABL transcript in acute Lymphoblastic Leukemia: a case report

The Philadelphia chromosome is usually express on about 30% acute B lymphoblastic leukemia. Most of Ph-positive acute lymphoblastic leukemia patients have ela2 BCR-ABL transcripts, other atypical fusion genes such as ela3 have been rare reported. We reported a case of Ph-positive B-acute lymphoblastic leukemia with a scare ela3 fusion transcript. She presented with a complex karyotype and showed good early response to imatinib and dasatinib but relapsed six months after diagnosis, and E255v, T315I mutations were successively detected in the ABL kinase region, then he switched to ponatinib and underwent allogeneic hematopoietic stem cell transplantation. But the Minimal Residual Disease increased after 16 months, the patient was treated with CD19 chimeric antigen receptor T cell immunotherapy, and changed to olverembatinib targeted therapy. This subgroup of acute lymphoblastic leukemia might have poorer prognosis than patients with common transcripts. we recommend the third-generation tyrosine-kinase inhibitor as a first choice for their initial therapy and allogeneic hematopoietic stem cell transplantation or immunotherapy and new clinical trials should be considered as early as possible.