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Updated: Aug 8, 2026
Flow Cytometry to Estimate Leukemia Stem Cells in Primary Acute Myeloid Leukemia and in Patient-derived-xenografts, at Diagnosis and Follow Up
Published on: March 26, 2018
[CD7, HLA-DR, CD38 positive acute undifferentiated leukemia with subcutaneous tumor and thymoma]
1Forth Department of Internal Medicine, Sapporo Medical University.
Insights
This case study reports on acute undifferentiated leukemia (AUL) with unique tumor presentations. Effective treatment involved high-dose cytarabine (ara-C) and combination chemotherapy, achieving complete remission (CR).
Area of Science:
- Hematology
- Oncology
- Genetics
Background:
- Acute undifferentiated leukemia (AUL) presents a diagnostic challenge.
- Co-occurrence of subcutaneous tumors and thymoma with AUL is rare.
- AUL generally has a poor prognosis and low complete remission (CR) rates.
Purpose of the Study:
- To report a unique case of AUL with subcutaneous tumor and thymoma.
- To detail the immunophenotypic and cytogenetic findings in this AUL case.
- To describe the treatment strategy and outcome for this challenging AUL presentation.
Main Methods:
- Immunophenotypic analysis of leukemic blasts.
- Cytogenetic analysis including chromosomal abnormality detection.
- Treatment with JALSG-ALL87 protocol followed by high-dose cytarabine (ara-C) and combination chemotherapy.
Main Results:
- Leukemic blasts were positive for CD7, HLA-DR, CD38, and CD34 (17.5%), negative for other lymphoid/myeloid antigens.
- Rearranged immunoglobulin heavy chain (IgH) and T cell receptor delta (TCR-delta) genes were observed.
- Initial treatment failed to achieve CR, but subsequent high-dose ara-C and combination chemotherapy (intermediate-dose ara-C, mitoxantrone, etoposide, prednisolone) resulted in CR.
Conclusions:
- This case highlights the complexity of AUL with extralesional manifestations.
- Aggressive combination chemotherapy, including high-dose ara-C, can be effective in refractory AUL.
- Further research into AUL subtypes and treatment optimization is warranted.
Abstract:
A case of acute undifferentiated leukemia (AUL), accompanied by subcutaneous tumor and thymoma is reported. The analysis of immunophenotype showed that the leukemic blasts were positive for CD7, HLA-DR, CD38 and CD34 in 17.5% but negative results were obtained for other lymphoid and myeloid antigens. The leukemic blasts had a rearranged immunoglobulin heavy chain (IgH) gene and T cell receptor delta (TCR-delta) chain gene chromosomal abnormality, 47, XY, +8, t(13; 17) (q12; q21), -17, +M was observed. In general, the CR rate is low and prognosis is poor in patients with AUL. In our case, CR was not achieved by the therapy with JALSG-ALL87 protocol, but was achieved by subsequent treatment with high dose ara-C therapy and combination chemotherapy including intermediate-dose ara-C, mitoxantrone, etoposide and prednisolone.
