{"title":"Therapy-Related Acute Lymphoblastic Leukemia with Plasmablastic Morphology after Myeloma: a Pitfall.","authors":"Huimei Ge, Dejun Xiao, Zhiqing Liu, Jing Xu","doi":"10.7754/Clin.Lab.2025.250917","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Therapy-related acute lymphoblastic leukemia (t-ALL) after multiple myeloma (MM) treatment is a rare complication linked to lenalidomide and autologous stem cell transplantation (ASCT). Diagnosing t-ALL vs. MM relapse is challenging when blasts show plasmablastic morphology.</p><p><strong>Methods: </strong>An elderly male with IgA-λ MM, previously treated with double ASCT and lenalidomide, presented with fatigue and hematochezia. Pancytopenia was noted. Bone marrow showed 35.0% plasmablastic cells, raising concern for relapse.</p><p><strong>Results: </strong>Flow cytometry confirmed CD34/TdT/CD19-positive B-ALL, not myeloma. Karyotype was normal; NGS revealed a DNMT3A mutation, typical of therapy-related leukemia. This supported t-B-ALL diagnosis.</p><p><strong>Conclusions: </strong>This case highlights a diagnostic pitfall where morphology misleads. Integrated lab analysis - especially flow cytometry - is essential to classify complex malignancies and guide therapy, underscoring therapy-related leukemogenesis in MM survivors.</p>","PeriodicalId":10384,"journal":{"name":"Clinical laboratory","volume":"72 8","pages":""},"PeriodicalIF":0.7000,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical laboratory","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.7754/Clin.Lab.2025.250917","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"MEDICAL LABORATORY TECHNOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Therapy-related acute lymphoblastic leukemia (t-ALL) after multiple myeloma (MM) treatment is a rare complication linked to lenalidomide and autologous stem cell transplantation (ASCT). Diagnosing t-ALL vs. MM relapse is challenging when blasts show plasmablastic morphology.
Methods: An elderly male with IgA-λ MM, previously treated with double ASCT and lenalidomide, presented with fatigue and hematochezia. Pancytopenia was noted. Bone marrow showed 35.0% plasmablastic cells, raising concern for relapse.
Results: Flow cytometry confirmed CD34/TdT/CD19-positive B-ALL, not myeloma. Karyotype was normal; NGS revealed a DNMT3A mutation, typical of therapy-related leukemia. This supported t-B-ALL diagnosis.
Conclusions: This case highlights a diagnostic pitfall where morphology misleads. Integrated lab analysis - especially flow cytometry - is essential to classify complex malignancies and guide therapy, underscoring therapy-related leukemogenesis in MM survivors.
期刊介绍：
Clinical Laboratory is an international fully peer-reviewed journal covering all aspects of laboratory medicine and transfusion medicine. In addition to transfusion medicine topics Clinical Laboratory represents submissions concerning tissue transplantation and hematopoietic, cellular and gene therapies. The journal publishes original articles, review articles, posters, short reports, case studies and letters to the editor dealing with 1) the scientific background, implementation and diagnostic significance of laboratory methods employed in hospitals, blood banks and physicians'' offices and with 2) scientific, administrative and clinical aspects of transfusion medicine and 3) in addition to transfusion medicine topics Clinical Laboratory represents submissions concerning tissue transplantation and hematopoietic, cellular and gene therapies.
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