Abstract
A Case Series of Clonally Distinct Treatment-related B-cell Acute Lymphoblastic Leukemia After Prior B-cell Malignancy
International Journal of Cancer Care and Delivery, Vol.5(Suppl 1), pp.S109-S110
09/17/2025
DOI: 10.53876/001a.129555
Abstract
Context
The pathogenesis of treatment-related B-cell acute lymphoblastic leukemia (tB-ALL) is not well understood, especially when it develops in patients with prior B-cell malignancies.
Objective
This study investigates the clonal relationship between B-cell malignancies and subsequent tB-ALL in 4 patients. Despite sharing a B-cell origin, the diseases were found to be clonally distinct. The clonoSEQ assay, using next-generation sequencing (NGS) to analyze VDJ rearrangements in immunoglobulin gene sequences, confirmed the clonal independence of tB-ALL from the initial B-cell malignancies in all 4 cases.
Design
Patient #1: Mr. H, 45, initially achieved remission from T-cell histiocyte-rich DLBCL with R-CHOP. 9 months later, he developed Ph-negative (Ph-) B-ALL. ClonoSEQ® assay identified 2 unique clones from DLBCL and 7 unique clones from B-ALL. He achieved complete remission (CR) with inotuzumab ozogamicin (IO) + mini-HCVD (cyclophosphamide, vincristine, and dexamethasone) and blinatumomab (blin).
Patient #2: Mr. M, 59, in remission from IgA lambda MM, developed Ph- B-ALL with CDKN2A loss on maintenance lenalidomide. ClonoSEQ® confirmed 4 unique clones from MM and 2 unique clones from B-ALL. He achieved MRD-negative remission with IO while continuing consolidation therapy (CT) with blin in sustained CR.
Patient #3: Mrs. Y, 67, achieved remission from plasmacytoma but later developed Ph- IKZF1 deleted B-ALL after 70 months of maintenance lenalidomide. The ClonoSEQ® identified 2 unique clones from MM and 2 unique clones from B-ALL. She achieved MRD negativity with IO+ miniHCVD followed by blin, and remains in CR during CT with blin.
Patient #4: Mrs. O, 74, developed Ph- B-ALL after 26 months of lenalidomide maintenance for MM. ClonoSEQ® identified 3 unique clones from MM and 2 unique clones from B-ALL. She is undergoing induction therapy with IO+ mini-HCVD.
Results
Factors contributing to tB-ALL include old age, genetic predispositions, lenalidomide maintenance, and cytogenetic anomalies. Advances in targeted therapies, like blin, IO, and CAR T-cell therapies, have improved responses and tolerance, even in older patients, as shown in the case series.
Conclusion
tB-ALL and prior B-cell malignancies share a B-cell origin but can be clonally distinct. Advanced NGS technologies, such as clonoSEQ®, are essential for understanding tB-ALL pathophysiology and developing personalized treatments.
Details
- Title: Subtitle
- A Case Series of Clonally Distinct Treatment-related B-cell Acute Lymphoblastic Leukemia After Prior B-cell Malignancy
- Creators
- Mehndi Dandwani - University of IowaPrajwal Dhakal - University of IowaGrerk Sutamtewagul - University of Iowa Health CareChristopher Strouse - University of IowaKittika Poonsombudlert - University of Iowa
- Resource Type
- Abstract
- Publication Details
- International Journal of Cancer Care and Delivery, Vol.5(Suppl 1), pp.S109-S110
- DOI
- 10.53876/001a.129555
- ISSN
- 2770-3533
- eISSN
- 2770-3533
- Language
- English
- Date published
- 09/17/2025
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984966342902771
Metrics
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