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Spatial Lineage Divergence at Diagnosis in a Pediatric KMT2A-Rearranged Leukemia Presenting with Concurrent AML and
Huan Zhang1, Qiuling Miao1, Yue Wang1
1Department of Pathology, Shenzhen Children's Hospital, Shenzhen, People's Republic of China.
Abstract:
We describe a 1-year-2-month-old boy with KMT2A-rearranged leukemia presenting with concurrent acute myeloid leukemia in bone marrow and B-lymphoblastic leukemia/lymphoma in a right calf mass. Both lesions harbored an identical KMT2A::MLLT10 fusion, confirming common clonal origin. This represents the first documented case of spontaneous "spatial lineage divergence" at diagnosis, distinct from therapy-induced lineage switch. The finding highlights the potential need for multi-site biopsy and molecular profiling in extramedullary disease.
