B-cell Acute Lymphoblastic Leukemia Following Myelodysplastic Syndromes: A Case Report and Literature Review

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Approximately 20–30% of MDS cases progress to acute myeloid leukemia, whereas transformation to acute lymphoblastic leukemia (ALL) is extremely rare. In this report, we present the case of a Chinese male patient who presented with MDS-refractory anemia with ringed sideroblasts, which developed into B-cell ALL. During disease transformation, the patient acquired novel gene mutations. By comparing the gene mutations identified at the initial MDS diagnosis with those observed at the time of transformation to ALL, we aim to elucidate the genetic alterations associated with disease progression. Furthermore, we provide a comprehensive review of 55 MDS cases reported in the literature so far. myelodysplastic syndromes acute lymphoblastic leukemia leukemia MDS ALL Figures Figure 1 Figure 2 Introduction Myelodysplastic syndromes (MDS) are a group of clonal disorders originating from hematopoietic stem cells, marked by ineffective blood cell production and diverse clinical presentations. Patients commonly experience complications arising from reductions in one or more blood cell lines, such as anemia, neutropenia, or thrombocytopenia. Another major clinical concern is the potential progression of MDS to acute myeloid leukemia (AML). Furthermore, individuals with MDS may face challenges related to long-term transfusion requirements, adverse effects of treatment, and occasionally, systemic manifestations including inflammatory or autoimmune phenomena(1). MDS are defined by the presence of fewer than 20% myeloblasts in both the bone marrow and peripheral blood, distinguishing them from acute leukemia. Meanwhile, approximately 30% of MDS cases progress to AML, whereas transformation to acute lymphoblastic leukemia (ALL) is extremely rare(2). To date, only 55 cases of MDS progressing to ALL have been reported, and the mechanisms underlying the transformation of MDS to ALL remain to be further explored. With recent advancements in genetic testing and next-generation sequencing (NGS) technologies, it is now possible to identify gene mutations that drive the progression of MDS to ALL. This study aims to elucidate gene mutations associated with the transformation of MDS to ALL by comparing the mutations present at the initial diagnosis of MDS with those detected at the time of transformation. Most existing studies have focused on the progression of MDS to AML, whereas the mechanisms and characteristics of MDS transforming into ALL remain insufficiently reported. We present the case of a Chinese male patient who acquired novel gene mutations during the disease transformation. He was diagnosed with B-cell ALL (B-ALL) that developed from MDS. This case provides rare long-term follow-up data together with dynamic insights into clonal genetic evolution. Furthermore, we analyzed data from 55 previously reported cases to gain a comprehensive understanding of the clinical characteristics of ALL transformed from MDS. Case presentation A 72-year-old man was initially evaluated for anemia and diagnosed with MDS nine years ago. Bone marrow aspiration at that time revealed 32% ringed sideroblasts (Fig. 1 ), and cytogenetic analysis demonstrated a normal male karyotype (46, XY). Molecular profiling identified a missense mutation in SF3B1 (p.K700E) with a variant allele frequency (VAF) of 48.19%, commonly associated with MDS with ring sideroblasts and favorable prognosis(3). Additional mutations were detected in JAK2 (p.V617F, VAF 5.72%), a well-known driver in myeloproliferative neoplasms, and CBL (VAF 1.00%), which has been associated with dysregulated RAS signaling and poor prognosis in myeloid malignancies. Based on the revised International Prognostic Scoring System (IPSS-R), the patient was classified as low-risk and received thalidomide, with sustained disease control. A follow-up bone marrow examination three years prior to relapse revealed only 1% blasts. In September 2024, the patient presented with a one-month history of progressive fatigue. Complete blood count showed leukocytosis (WBC 13.55 × 10⁹/L), hemoglobin of 113 g/L, a normal platelet count of 230 × 10⁹/L, and 32% circulating blasts. Flow cytometry of peripheral blood revealed a blast population comprising approximately 50% of nucleated cells, expressing TdT, cytoplasmic CD79a, CD19, and CD34, and negative for MPO and other myeloid markers—features consistent with B-ALL (Fig. 2 A). Bone marrow aspiration confirmed 53.75% blasts with variable morphology and prominent nucleoli (Fig. 2 B). Cytogenetic analysis again showed a normal male karyotype. Immunohistochemical staining was positive for CD79a and Pax-5, confirming B-cell lineage. Bone marrow flow cytometry demonstrated 60.5% blasts with a similar immunophenotype (Fig. 2 C). Next-generation sequencing (NGS) performed at relapse revealed clonal persistence of the original SF3B1 p.K700E mutation (VAF 47.31%), while JAK2 and CBL mutations were no longer detected. In contrast, multiple new somatic mutations were acquired, including GNB1 (p.K57N, VAF 47.34%), NF1 (p.R1241*, VAF 12.45%), CREBBP (compound variants), ATRX (p.K307fs, VAF 36.71%), NFE2 (p.P142fs, VAF 8.03%). The first course included vindesine, cyclophosphamide and dexamethasone (VCP). However, post-treatment bone marrow evaluation showed 38.23% blast cells and flow cytometry detected 40.65% abnormal B cells, indicating the lack of complete remission. During the subsequent three cycles of induction chemotherapy, the patient was treated with vindesine, idarubicin, cyclophosphamide, and dexamethasone (VICP). In February 2025, bone marrow indicated a partial response (7% blasts on morphology; 8.08% aberrant B-cell population by flow cytometry). The patient developed intolerable severe bone marrow suppression (mainly severe agranulocytosis/anemia), necessitating a change to vindesine-prednisone (VP) regimen. After the final course of chemotherapy, the patient died of respiratory failure caused by a severe pulmonary fungal infection. Discussion Myelodysplastic neoplasm with SF3B1 mutation (MDS-SF3B1) represents a distinct clinicopathological entity characterized by SF3B1 mutations and typically associated with ring sideroblasts, low blast counts, and a generally favorable prognosis(4). Nonetheless, in rare cases, such as ours, the disease can transform into ALL, particularly of B-cell lineage. Genomic analysis at transformation revealed clonal persistence of SF3B1 p.K700E, alongside acquisition of multiple novel mutations, including GNB1 p.K57N, NF1 p.R1241*, CREBBP compound variants, ATRX p.K307fs, and NFE2 p.P142fs. Notably, JAK2 p.V617F and CBL mutations detected at initial diagnosis were absent at transformation. This can be explained by the fact that MDS is characterized by heterogeneous clonal populations with various driver mutations. During disease progression, clonal evolution often occurs with new subclones emerging that can outcompete the original clones—a process called "clone sweeping." Mutations in some genes may drive the evolution toward more aggressive disease states(5, 6). Although the role of gene mutations in the transformation of MDS to ALL has not been fully elucidated, investigation of certain newly acquired mutations and their associations with ALL suggests that they may serve as potential drivers of leukemic evolution. ATRX belongs to the switch/sucrose non-fermentable (SWI/SNF) family of chromatin remodeling proteins and plays an essential role in regulating gene expression and maintaining genomic stability. Disturbance of ATRX function can lead to defective sister chromatid cohesion and congression, telomere dysfunction, and aberrant patterns of DNA methylation(7). Adult relapsed B-cell precursor ALL patients have shown a higher likelihood of accumulating mutations in chromatin remodeling factors such as ATRX(8). Existing studies have demonstrated that ATRX is a novel putative driver gene in ALL, associated with relapse or detected in rising clones at relapse. Although the exact mechanisms by which ATRX loss promotes cancer progression remain unclear, all ATRX mutations reported to date are predicted to be deleterious(8). The patient demonstrated poor response to standard vindesine-based chemotherapy regimens, achieving only partial remission. The presence of CREBBP mutations may have contributed to chemoresistance. These mutations impair histone acetyltransferase activity and transcriptional coactivator functions, disrupting gene regulation that controls cell proliferation and response to treatment(9, 10). For elderly patients with B-ALL recommend consideration of immunotherapy such as blinatumomab, or CAR-T cells where feasible (11, 12). Unfortunately, our patient’s frailty and infectious complications precluded such interventions, ultimately leading to treatment failure and death from fungal pneumonia. Interestingly, our patient acquired a GNB1 mutation during transformation from MDS to B-ALL. GNB1 mutations have been predominantly reported in myeloid neoplasms(13) and have also been linked to resistance to tyrosine kinase inhibitors in certain leukemias, as they can activate alternative survival pathways such as PI3K/AKT/mTOR and MAPK, thereby enabling leukemic cells to bypass targeted therapy(14). However, its role in lymphoid leukemogenesis remains poorly understood, and reports of GNB1 mutations in B-ALL are exceedingly rare. Although NF1 and NFE2 mutations were detected at the time of transformation, current evidence suggests that their direct association with lymphoid leukemogenesis is relatively weak, and their role in the progression from MDS to ALL remains uncertain. In addition to the aforementioned case, our study compiled 55 cases of MDS transforming into ALL from 1980 to 2024 (Table 1 ). The majority of these patients were male, accounting for 71.4% of the cohort. The median age at onset for the entire cohort was 56.5 years (interquartile range: 31.75–69 years). The median time to transformation to ALL was 11 months (interquartile range: 3.5–32 months). Among the ALL subtypes following transformation, 65.2% were B-ALL, 28.3% were T-ALL, and three cases were classified as biphenotypic ALL. Among the MDS patients with chromosomal abnormalities, the most common abnormality was the deletion of the long arm of chromosome 5, observed in 46.7% (7/15) of cases, and patients with this isolated abnormality were more likely to achieve favorable remission after induction chemotherapy. The overall median survival after transformation was 3 months (interquartile range: 3–17.25 months). Patients with complex karyotypes at baseline or those who developed complex karyotypes during transformation to ALL exhibited poor prognoses. During the transformation from MDS to ALL, 68% (17/25) of patients acquired new cytogenetic abnormalities, and 68.75% (11/16) of these patients experienced unfavorable outcomes. However, there is currently no conclusive evidence that establishes a direct relationship between chromosomal abnormalities and disease transformation. Poor prognosis was also associated with characteristics such as intolerance to induction chemotherapy, inadequate treatment response, and early relapse post-remission. Consistent with these findings, our patient developed novel mutations at transformation and had limited response to chemotherapy, supporting the view that clonal evolution drives MDS progression to ALL and contributes to dismal outcomes. Table 1 55 cases of MDS transforming into ALL from 1980 to 2024 Sex Age (y) Chromosomal and molecular abnormalities of MDS Therapeutic regimen of MDS Time to transformation (m) Subtype of ALL Chromosomal and molecular abnormalities of ALL Treatment Outcome Overall survial after transformation (m) Ref. M 53 N.A. Pyridoxine, folic acid, and vitamin B12 50 N.A. N.A. Complete remission (CR) for 11 months, followed by a relapse and then died 2 weeks later due to extensive bilateral bacterial pneumonia 12 (15) M 67 N.A. Pyridoxine, folic acid, and nandrolone decanoate 24 N.A. 47 and 48 chromosomes CR for 3 months, followed by a relapse and then died in heart failure 6 weeks later 9 (16) M 58 N.A. No treatment 20 N.A. N.A. Experienced intracerebral hemorrhage and died 1.5 (17) F 50 46,XX Blood transfusion 3 N.A. 46,XX CR 60 (18) M 75 N.A. Pyridoxine and folic acid 3 T-ALL 46,XY Died from gastrointestinal bleeding 3 (19) M 72 N.A. Steroids 14 Biphenotypic (myeloid and null-cell ALL) 46,XY PR after 2 courses of treatments, relapsed after 4 months and PR after re-start of treatment N.A. (20) M 65 N.A. No treatment 19 N.A. 94, XXYY, + 13, +13 CR after 4-weeks treatment, replased later, PR after 4-weeks re-start of treatment N.A. (21) F 28 46,XX Blood transfusion and oxymetholone 11 pre-B ALL (L1) 46,XX No remission was obtained and died of sepsis and gastrointestinal haemorrhages 3 (22) M 90 N.A. Blood transfusion 5 N.A. N.A. Died of pseudomonas sepsis a few days later 0 (23) F 55 46,XX t(4;11), (q21;q23) Radiotherapy 1 N.A. 43,XX t(4;11),-3,-5,-7 CR after re-induction chemotherapy, relapsed 3 months later and died of spinal cord compression 4 months later 7 (24) M 79 N.A. Blood transfusion 5 Biphenotypic (B-, T- and myeloid lineage feature) N.A. Died soon N.A. (25) M 3 46,XY aclarubicin and Behenoyl-AraC. 32 N.A. 46,XY,t(9:22)(q34:q11)//BCR-ABL(P210) N.A. N.A. (26) M 53 N.A. No treatment 44 T-ALL (L2) 46,XY CR for 2 months, then Intracranial relapsed and died of E. coli sepsis with acute respiratory distress syndrome 2 (27) M 46 N.A. Supportive 1.5 pre-B ALL 49,XY,+4,+6,+8,inv(14)(q11q32)[ 15 ]/48,X,PY,c4,c6,c8,inv(14)(q11q32)[ 4 ]/46,XY[ 5 ] CR after 1 month N.A. (28) M 0.5 46,XY Blood transfusion 5 B-ALL 46,XY CR N.A. (29) M 54 46,XY Anabolic steroid and blood transfusion 30 B-ALL 46,XY,t(9;22)(q34;q11),20q–, 46,XY,20q–//BCR-ABL(P190) No remission was obtained N.A. (30) M 69 N.A. N.A. 6 T-ALL 48,XY,+8[ 1 ] /46,XY [ 9 ] CR for 15 months N.A. (31) M 78 N.A. N.A. 5 T-ALL N.A. No remission was obtained 1 (31) F 72 N.A. N.A. 5 T-ALL 46,XX CR for 4.5 months 20 (31) M 67 N.A. N.A. 18 T-ALL 45,XY,-7 No remission was obtained 3 (31) M 65 N.A. N.A. 4 T-ALL 47,XY,+8[ 7 ]/48,XY,+8,+13[ 1 ]/48,XY,+8,+20[ 1 ]/46,XY [ 7 ] CR for 45 months N.A. (31) M 72 N.A. N.A. 5 T-ALL 46,XY CR for 12 months N.A. (31) M 4 N.A. N.A. N.A. N.A. 46,XY,5q- N.A. 19 (32) F 62 N.A. N.A. 2 B-ALL N.A. CR for 2 years, MDS relapsed with bone marrow fibrosis, and 3 months later, acute megakaryoblastic leukemia developed. The patient died of sepsis." 27 (33) M 1 N.A. N.A. 1.5 Biphenotypic ((AML M5a/T-lineage feature) 46,XY,t(X;9;11)(p21.1;p22;q23) N.A. N.A. (34) M 3 44,XY,r(11)(p15q23),-der(12;20)t(12;20)(-p13;q11.2)t(12;20)(-q24.3;q11.2),-17,-2 Cytosine arabinosidem etoposide, daunomycin, 6-thioguanine, and dexamethasone 4 Pre-B ALL 45, XY, -9, -22, + 21 Return the original RAEB marrow morphology, then died from cytomegalovirus pneumonitis and graft versus host disease N.A. (35) M 70 N.A. N.A. 22 B-ALL N.A. N.A. N.A. (36) F 43 47,XY,+8[ 20 ] No treatment 31 B-ALL 47,XY,+8[ 14 ]/del(9p),-add(10p)[ 6 ] Reduction in bone marrow blasts N.A. (37) M 43 45, XY, del(5)(q22q33), -7, add(12)(p13).[ 29 ]/46 XY[ 1 ] Hydroxyurea to treat eosinophilia 11 B-ALL 45, XY, del(5)(q22q33), -7, add(12) (p13). [ 5 ]/46 XY[0] Tolerated induction chemotherapy poorly and died of sepsis and multiorgan failure N.A. (38) M 50 44, X, -Y, der(5)t(5;7)(q13p11), -7, add(12)(p11), del(13)(q12q14)[ 14 ]/41, idem, -10, -14, -8, -20, +mar[ 1 ]/44, X, -Y, der(5)t(5;12)(q11q13), -7, -12, del(13)(q12q14) + mar[ 1 ]/46, XY, t(3;11)(p25q13)[ 1 ]/46, XY[ 3 ] Vitamin D3 4 B-ALL (L3) 44, X, -Y, der(5)t(5;7)(q13p11), -7, add(12)(p11), del(13)(q12q14)[ 5 ]/44, idem, add(3)(q11)[ 3 ]/45, idem, add(9)(q11), + 12, -add(12), der(14)t(9;14)(q13p11), ins(14;?)(p11;?), +mar1[ 1 ]/47, X, -Y, t(8;22)(q24q11), del(13)(q12q14), -19, + 21, +mar2[ 8 ]/46, X, -Y, t(8;22)(q24q11), del(13)(q12q14), -19, + 21, +mar2[ 3 ]//c-myc CR, morphological remission N.A. (39) F 68 44,XX,-3,des(5)(q13q31),der(12),del(12)(p11p12), add(12)(q24),-13,del(20)(q11)[ 16 ]/43,XX,-3,des(5)(q13q31),der(12),del(12)(p11p12),add(12)(q24),-13,-20[ 1 ]/45,XX,-3,del(5)(q13q31),der(12),del(12)(p11p12),add(12)(q24),-13,-20,+21,+22[ 1 ]/46,XX[ 2 ] No treatment 5 B-ALL (L3) 45,XX,-3,del(5)(13q31)[ 4 ]/43,XX,-3,del(5)(q13q31),-7,der(12),del(12)(p11p12),add(12)(q24),-13,-20[ 1 ]/45,XX,-3,del(5)(q13q31),der(12)(p11p12),add(12)(q24),-13,-20,+21,+22[ 1 ]/46,XX [ 13 ] Died of multiorgan failure N.A. (40) M 57 N.A. N.A. 5 B-ALL (L3) N.A. N.A. N.A. (41) M 66 47,XY,+8[ 20 ] Cyclosporin and blood transfusion 32 Pre-B ALL 47,XY,+8[ 20 ] Died of sepsis N.A. (42) M 9 46,XY Cyclosporine, prednisolone and blood transfusion 14 Pre-B ALL N.A. N.A. N.A. (43) M 20 N.A. Blood transfusion 1 T-ALL N.A. CR for at least 3 years N.A. (44) M 69 N.A. Blood transfusion 12 T-ALL N.A. Died of multiple organ failure N.A. (45) F 5 N.A. Blood transfusion and broad spectrum antibiotic 4 B-ALL N.A. CR for at least 1.5 years N.A. (46) M 68 47,XY,+Y,del(5)(q13q33)[ 19 ]/47,XY,+Y[ 1 ] Lenalidomide 32 B-ALL 47,XY,+Y[ 16 ]/47, idem, del(5)(q13q31)[ 2 ]/47,XY,+Y,del(20)(q11.2q13)[cp2] Died soon N.A. (47) F 83 46,XX,del(5)(q13q33)[ 20 ] Lenalidomide and erythropoietin 72 B-ALL 46,XX,del(5)(q13q33)[ 18 ]/46,XX[ 2 ]/46,XX,del(5)(q13q33),del(20)(q11.2q13.1)[ 1 ] Died soon N.A. (47) F 53 46,XX Erythropoietin and G-CSF 2 Pre-B ALL N.A. CR for at least 7 months N.A. (48) M 28 46,XY,del(5)(q22q35)[ 6 ]/46,XY[ 8 ] Testosterone, erythropoietin, thalidomide, and blood transfusion 39 Pre-B ALL 46,XY,t(3;3)(q21;q26),del(11p)[ 8 ]/46,XY,del(5q)[ 2 ] Died of serious infection N.A. (49) M 67 46,XY,del(20)(q11;q13)[ 5 ]/46,XY[ 10 ] Thalidomide 33 B-ALL N.A. Died of a hemorrhagic stroke 1 (50) F 8 46,XX Supportive treatment 3 B-ALL del(13q14.3) Died of tumor lysis syndrome 0 (51) M 2 47,XY,+8 Antibiotic therapy 3 B-ALL N.A. CR for at least 1 year N.A. (52) F 5 46,XX Antibiotic therapy and blood transfusion 2 B-ALL N.A. CR for at least 5 year N.A. (52) F 79 45, XX,t(5;9;?)(q13;q12;?),-7,del(12)(p11.2p13),-20,- mar/MLL amplification Erythropoietin 40 T-ALL N.A. Died of multi-organ failure N.A. (53) F 81 46, XX, del(5)(q13q33)/TP53、TET2 mutation N.A. 0 B-ALL 46, XX, del(5)(q13q33)/TP53、TET2 mutation CR in 28 days N.A. (54) M 33 46, XY No treatment 47 Pre-B ALL 46,XY/ASXL1 mutation Died of severe pulmonary infection N.A. (55) M 69 46, XY, del(5)(q22q35)/EZH2 mutation Lenalidomide 27 B-ALL 46, XY/EZH2 mutation Achieved CR in 2 months and maintained for at least 7 months N.A. (56) F 50 46, XX [ 20 ]/BCOR、DNMT3A、PTPN11、RUNX1 mutation First induction: idarubicin, clofarabine, cytarabine Second induction: cytarabine, amsacrine, clofarabine Consolidation: autologous hematopoietic stem cell transplantation with busulfan/cyclophosphamide 40 Early pre-B ALL 46,XX,t(6;11)(q21;23) [ 9 ]/46,XX [ 11 ]/WT1、DNMT3A、BCOR、PTPN11、RUNX1、STAG2 mutation CR N.A. (57) F 56 46,XX[ 25 ] /CBL、IDH2、JAK2、SRSF2、P95H mutation Idarubicin, cytosine arabinoside, etoposide 108 Early pre-B ALL 46, XX, del(9)(p11) [ 4 ]/46, XX,add(2)(q32-33),i(9)(q10)[ 4 ]/46, XX [ 12 ]//CBL、IDH2、JAK2、SRSF2 mutation Unable to tolerate induction therapy N.A. (57) M 88 46, XY, del(20)(q11q13) [ 8 ];idem,del(5) (q31q34) [ 5 ]; 46XY [ 7 ] Glucocorticosteroids and vincristine 0 T-ALL 46, XY, del(20)(q11q13) [ 8 ];idem,del(5) (q31q34) [ 5 ]; 46XY [ 7 ] Unable to tolerate induction therapy 1 (57) M 58 N.A. Blood transfusion, erythropoietin, cyclosporin A, stanozolol, and reconstituted blood platelets 48 B-ALL 47, XY, + 21 CR in 1 course of therapy N.A. (58) M 56 45, X erythropoietin, lenalidomide, and blood transfusion 144 B-ALL 45, X Unable to tolerate multiple chemotherapy regimens, the patient opted for palliative treatment 24 (59) M 12 46, XX, del(1q31.3q32.1)//RUNX1、PHF6、JAX3、CDKN2B mutation N.A. 0 T-ALL 46, XX, del(1q31.3q32.1)//RUNX1、PHF6、JAX3、CDKN2B mutation Achieved CR for at least 14 months after hematopoietic stem cell transplantation N.A. (60) Conclusion In summary, we report a rare case of MDS with an SF3B1 mutation that subsequently transformed into B-ALL after nearly a decade of disease stability. The transformation was accompanied by clonal persistence of the SF3B1 mutation and the emergence of additional genetic alterations, including GNB1, NF1, CREBBP, ATRX, and NFE2, suggesting that clonal evolution and acquisition of new mutations may play a pivotal role in driving lymphoid leukemic transformation. Our case highlights the poor prognosis of MDS-derived ALL, characterized by limited response to conventional chemotherapy and high treatment-related mortality. Given the increasing availability of targeted agents and immunotherapies such as blinatumomab and CAR T-cell therapy(11, 12), future management strategies should focus on integrating genomic profiling into risk stratification to optimize therapeutic decision-making. Further studies are warranted to clarify the molecular mechanisms underlying this rare transformation and to establish tailored therapeutic approaches for affected patients Declarations Author contributions Writing-original draft preparation, H.Y.D.; writing-review and editing, J.J.; visualization, H.Y.D., J.J.; supervision, W.Y.F., H.Q.L., J.J. All authors have read and agreed to the published version of the manuscript. Acknowledgements Not applicable. Ethics approval and consent to partcipate The patient has consented to the submission of the case report for submission to the journal. Patients signed informed consent regarding publishing their data and photographs. Funding Not applicable. Competing interests No competing interests declared. Availability of data and material Data and materials available on request by emails to the corresponding authors due to privacy/ethical restrictions. Ethics Approval The Ethics Committee of Shaoxing People's Hospital determined that formal ethics approval was not required for this case report, in accordance with institutional policies on single-case retrospective studies. Consent to Participate and Consent to Publish Written informed consent was obtained from the patient for participation in this study and for publication of the case details and any accompanying images. References Greenberg PL, Stone RM, Al-Kali A, Bennett JM, Borate U, Brunner AM, et al. NCCN Guidelines® Insights: Myelodysplastic Syndromes, Version 3.2022. J Natl Compr Canc Netw. 2022;20(2):106-17. Menssen AJ, Walter MJ. Genetics of progression from MDS to secondary leukemia. Blood. 2020;136(1):50-60. Malcovati L, Papaemmanuil E, Bowen DT, Boultwood J, Della Porta MG, Pascutto C, et al. Clinical significance of SF3B1 mutations in myelodysplastic syndromes and myelodysplastic/myeloproliferative neoplasms. Blood. 2011;118(24):6239-46. 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Acute biphenotypic leukaemia (myeloid and null-ALL type) supervening in a myelodysplastic syndrome. Br J Haematol. 1985;61(3):525-9. Ascensao JL, Kay NE, Wright JJ, Arthur D, Finkel B, Rydell R, et al. Lymphoblastic transformation of myelodysplastic syndrome. Am J Hematol. 1986;22(4):431-4. Bonati A, Delia D, Starcich R. Progression of a myelodysplastic syndrome to pre-B acute lymphoblastic leukaemia with unusual phenotype. Br J Haematol. 1986;64(3):487-91. Nagler A, Brenner B, Tatarsky I. Secondary refractory anemia with excess of blasts in transformation terminating as acute lymphoblastic leukemia. Acta Haematol. 1986;76(2-3):164-5. Stark AN, Scott CS, Bhatt B, Roberts BE. Myelodysplastic syndrome coexisting with acute lymphoblastic leukaemia. J Clin Pathol. 1986;39(7):728-30. Serke S, Stein H, Anagnostopoulos I, Schmidt C, Neubauer A, Siebert W, et al. Acute leukaemia with B- and T-lymphoid and myeloid characteristics in a patient with a myelodysplastic syndrome. 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Rossbach HC, Sutcliffe MJ, Chamizo W, Haag MM, Grana NH, Washington KR, et al. Pre-B acute lymphoblastic leukemia in a 3-year-old boy with pre-acute myelogenous leukemia myelodysplastic syndrome: cytogenetic evidence of common early progenitor cell ontogeny. J Pediatr Hematol Oncol. 1998;20(4):347-52. Pajor L, Matolcsy A, Vass JA, Méhes G, Marton E, Szabó F, et al. Phenotypic and genotypic analyses of blastic cell population suggest that pure B-lymphoblastic leukemia may arise from myelodysplastic syndrome. Leuk Res. 1998;22(1):13-7. Mishima A, Aoba M, Yamaji S, Taguchi J, Kanamori H, Motomura S, et al. Progression of a myelodysplastic syndrome with trisomy 8 to acute lymphoblastic leukemia. Am J Hematol. 1998;58(4):342. Follows GA, Owen RG, Ashcroft AJ, Parapia LA. Eosinophilic myelodysplasia transforming to acute lymphoblastic leukaemia. J Clin Pathol. 1999;52(5):388-9. Ikeda T, Sato K, Yamashita T, Kanai Y, Kuwada N, Matsumura T, et al. Burkitt's acute lymphoblastic leukaemia transformation after myelodysplastic syndrome. Br J Haematol. 2001;115(1):69-71. Sato N, Nakazato T, Kizaki M, Ikeda Y, Okamoto S. Transformation of myelodysplastic syndrome to acute lymphoblastic leukemia: a case report and review of the literature. Int J Hematol. 2004;79(2):147-51. Zainina S, Cheong SK. Myelodysplastic syndrome transformed into Acute Lymphoblastic Leukaemia (FAB:L3). Clin Lab Haematol. 2006;28(4):282-3. Disperati P, Ichim CV, Tkachuk D, Chun K, Schuh AC, Wells RA. Progression of myelodysplasia to acute lymphoblastic leukaemia: implications for disease biology. Leuk Res. 2006;30(2):233-9. Goel R, Kumar R, Bakhshi S. Transformation of childhood MDS-refractory anemia to acute lymphoblastic leukemia. J Pediatr Hematol Oncol. 2007;29(10):725-7. Naithani R, Kumar R, Saxena R, Mahapatra M. Transformation of myelodysplastic syndrome to T-cell acute lymphoblastic leukemia in a young adult. Pediatr Hematol Oncol. 2009;26(2):100-2. Serefhanoglu S, Goker H, Buyukasik Y, Sayinalp N, Ozcebe OI. Transformation of adult myelodysplastic syndrome-refractory anemia to acute T-cell lymphoblastic leukemia. J Natl Med Assoc. 2009;101(4):370-2. Gupta V, Bhatia B. Transformation of myelodysplastic syndrome to acute lymphoblastic leukemia in a child. Indian J Hematol Blood Transfus. 2010;26(3):111-3. Agostino NM, Ahmed B, Popescu D, Gheith S. Transformation of the 5q- syndrome to acute lymphoblastic leukemia: a report of two cases and review of the literature. Int J Clin Exp Pathol. 2011;4(3):322-6. Algarni AA, Akhtari M, Fu K. Myelodysplastic syndrome with myelofibrosis transformed to a precursor B-cell acute lymphoblastic leukemia: a case report with review of the literature. Case Rep Hematol. 2012;2012:207537. Liu D, Chen S, Pan J, Zhu M, Wu N, Zhu F, et al. Acquired EVI1 rearrangement involved in the transformation from 5q- syndrome to pre-B lymphocytic leukemia in a Chinese patient. Int J Hematol. 2012;96(6):806-9. Rohr SS, Pelloso LA, Borgo Ados S, de Rezende JG, Jr., Silva MR, Yamamoto M, et al. RARS with fibrosis and del(20q) transformed into ALL. Med Oncol. 2012;29(5):3570-3. Koh YR, Cho EH, Park SS, Park MY, Lee SM, Kim IS, et al. A rare case of transformation of childhood myelodysplastic syndrome to acute lymphoblastic leukemia. Ann Lab Med. 2013;33(2):130-5. Guillén M, Madero L, Parra L, Hernández C, Herrero B, Carceller F, et al. [Transformation of myelodysplastic syndrome to acute lymphoblastic leukemia: 2 new cases]. An Pediatr (Barc). 2013;78(6):393-7. Zeidan A, Faltas B, Fricke W, Gore S, Ketterling R, Sham R. Sustained remission in a patient with myelodysplastic syndrome and a complex karyotype after erythropoiesis-stimulating therapy followed by colonic T-cell lymphoblastic lymphoma. Leuk Lymphoma. 2013;54(7):1534-7. Jain P, Tang G, Konoplev SN, Kanagal-Shamanna R, Wang SA, Pemmaraju N, et al. Synchronous del5q myelodysplastic syndrome (del5qMDS) and adult B-cell acute lymphoblastic leukemia (B-ALL) with TET2 and TP53 mutations. Am J Hematol. 2016;91(3):354-5. Guo ZP, Tan YH, Li JL, Xu ZF, Chen XH, Xu LR. Acute pro-B-Cell lymphoblastic leukemia transformed from myelodysplastic syndrome with an ASXL1 missense mutation: A case report with literature review. Oncol Lett. 2018;15(6):9745-50. Burgos S, Montalban-Bravo G, Fuente L, Jabbour EJ, Kanagal-Shamanna R, Soltysiak KA, et al. Novel EZH2 mutation in a patient with secondary B-cell acute lymphocytic leukemia after deletion 5q myelodysplastic syndrome treated with lenalidomide: A case report. Medicine (Baltimore). 2019;98(1):e14011. Martins F, Kruszewski M, Scarpelli I, Schoumans J, Spertini O, Lübbert M, et al. Characterization of myelodysplastic syndromes progressing to acute lymphoblastic leukemia. Ann Hematol. 2021;100(1):63-78. Zhu YJ, Ma XY, Hao YL, Guan Y. Myelodysplastic syndrome transformed into B-lineage acute lymphoblastic leukemia: A case report. World J Clin Cases. 2021;9(19):5191-6. Bazinet A, Heath J, Chong AS, Simo-Cheyou ER, Worme S, Rivera Polo B, et al. Common clonal origin of chronic myelomonocytic leukemia and B-cell acute lymphoblastic leukemia in a patient with a germline CHEK2 variant. Cold Spring Harb Mol Case Stud. 2021;7(3). Wang CP, Ferreira JE, Placek A, Aguayo-Hiraldo P, Raca G, Wood BL, et al. A de novo germline RUNX1 variant preceding development of concurrent T-lymphoblastic leukemia and myelodysplastic syndrome. Leuk Lymphoma. 2024;65(9):1357-61. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 18 Nov, 2025 Reviews received at journal 11 Nov, 2025 Reviewers agreed at journal 15 Oct, 2025 Reviewers invited by journal 08 Oct, 2025 Editor assigned by journal 02 Oct, 2025 Submission checks completed at journal 02 Oct, 2025 First submitted to journal 29 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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14:30:37","extension":"html","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":211646,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7745943/v1/407663782231bfa568da25e2.html"},{"id":93947630,"identity":"99ce3563-9df9-4740-912f-9cdb76ca1951","added_by":"auto","created_at":"2025-10-20 14:30:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1141910,"visible":true,"origin":"","legend":"\u003cp\u003eBone marrow smear at initial diagnosis of myelodysplastic syndromes showed marked erythroid hyperplasia with dysplastic features, and ring sideroblasts accounted for 32% of erythroid precursors.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7745943/v1/6bbcbffd3056314da07567c0.png"},{"id":93948279,"identity":"5bdcb89b-ed11-41f9-b339-1c8c24298cd8","added_by":"auto","created_at":"2025-10-20 14:38:37","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":753240,"visible":true,"origin":"","legend":"\u003cp\u003eLaboratory test results at the time of transformation to B cell acute lymphoblastic leukemia. (A) Flow cytometry of peripheral blood showed that abnormal precursor B lymphoblasts accounted for 50.0% of nucleated cells. (B) Bone marrow smear revealed 53.75% blasts. (C) Bone marrow flow cytometry showed that abnormal precursor B lymphoblasts accounted for 60.5% of nucleated cells.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7745943/v1/11cc390122cfe3a4cdd56de8.png"},{"id":93949497,"identity":"baadec3b-f89b-4065-bfce-c2db963fe350","added_by":"auto","created_at":"2025-10-20 14:46:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2645492,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7745943/v1/a7940898-3bf2-4ed6-b93a-b12370078100.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"B-cell Acute Lymphoblastic Leukemia Following Myelodysplastic Syndromes: A Case Report and Literature Review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMyelodysplastic syndromes (MDS) are a group of clonal disorders originating from hematopoietic stem cells, marked by ineffective blood cell production and diverse clinical presentations. Patients commonly experience complications arising from reductions in one or more blood cell lines, such as anemia, neutropenia, or thrombocytopenia. Another major clinical concern is the potential progression of MDS to acute myeloid leukemia (AML). Furthermore, individuals with MDS may face challenges related to long-term transfusion requirements, adverse effects of treatment, and occasionally, systemic manifestations including inflammatory or autoimmune phenomena(1). MDS are defined by the presence of fewer than 20% myeloblasts in both the bone marrow and peripheral blood, distinguishing them from acute leukemia. Meanwhile, approximately 30% of MDS cases progress to AML, whereas transformation to acute lymphoblastic leukemia (ALL) is extremely rare(2). To date, only 55 cases of MDS progressing to ALL have been reported, and the mechanisms underlying the transformation of MDS to ALL remain to be further explored.\u003c/p\u003e\u003cp\u003eWith recent advancements in genetic testing and next-generation sequencing (NGS) technologies, it is now possible to identify gene mutations that drive the progression of MDS to ALL. This study aims to elucidate gene mutations associated with the transformation of MDS to ALL by comparing the mutations present at the initial diagnosis of MDS with those detected at the time of transformation.\u003c/p\u003e\u003cp\u003eMost existing studies have focused on the progression of MDS to AML, whereas the mechanisms and characteristics of MDS transforming into ALL remain insufficiently reported. We present the case of a Chinese male patient who acquired novel gene mutations during the disease transformation. He was diagnosed with B-cell ALL (B-ALL) that developed from MDS. This case provides rare long-term follow-up data together with dynamic insights into clonal genetic evolution. Furthermore, we analyzed data from 55 previously reported cases to gain a comprehensive understanding of the clinical characteristics of ALL transformed from MDS.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 72-year-old man was initially evaluated for anemia and diagnosed with MDS nine years ago. Bone marrow aspiration at that time revealed 32% ringed sideroblasts (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), and cytogenetic analysis demonstrated a normal male karyotype (46, XY). Molecular profiling identified a missense mutation in SF3B1 (p.K700E) with a variant allele frequency (VAF) of 48.19%, commonly associated with MDS with ring sideroblasts and favorable prognosis(3). Additional mutations were detected in JAK2 (p.V617F, VAF 5.72%), a well-known driver in myeloproliferative neoplasms, and CBL (VAF 1.00%), which has been associated with dysregulated RAS signaling and poor prognosis in myeloid malignancies. Based on the revised International Prognostic Scoring System (IPSS-R), the patient was classified as low-risk and received thalidomide, with sustained disease control. A follow-up bone marrow examination three years prior to relapse revealed only 1% blasts.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn September 2024, the patient presented with a one-month history of progressive fatigue. Complete blood count showed leukocytosis (WBC 13.55 \u0026times; 10⁹/L), hemoglobin of 113 g/L, a normal platelet count of 230 \u0026times; 10⁹/L, and 32% circulating blasts. Flow cytometry of peripheral blood revealed a blast population comprising approximately 50% of nucleated cells, expressing TdT, cytoplasmic CD79a, CD19, and CD34, and negative for MPO and other myeloid markers\u0026mdash;features consistent with B-ALL (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). Bone marrow aspiration confirmed 53.75% blasts with variable morphology and prominent nucleoli (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). Cytogenetic analysis again showed a normal male karyotype. Immunohistochemical staining was positive for CD79a and Pax-5, confirming B-cell lineage. Bone marrow flow cytometry demonstrated 60.5% blasts with a similar immunophenotype (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC). Next-generation sequencing (NGS) performed at relapse revealed clonal persistence of the original SF3B1 p.K700E mutation (VAF 47.31%), while JAK2 and CBL mutations were no longer detected. In contrast, multiple new somatic mutations were acquired, including GNB1 (p.K57N, VAF 47.34%), NF1 (p.R1241*, VAF 12.45%), CREBBP (compound variants), ATRX (p.K307fs, VAF 36.71%), NFE2 (p.P142fs, VAF 8.03%).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe first course included vindesine, cyclophosphamide and dexamethasone (VCP). However, post-treatment bone marrow evaluation showed 38.23% blast cells and flow cytometry detected 40.65% abnormal B cells, indicating the lack of complete remission. During the subsequent three cycles of induction chemotherapy, the patient was treated with vindesine, idarubicin, cyclophosphamide, and dexamethasone (VICP). In February 2025, bone marrow indicated a partial response (7% blasts on morphology; 8.08% aberrant B-cell population by flow cytometry). The patient developed intolerable severe bone marrow suppression (mainly severe agranulocytosis/anemia), necessitating a change to vindesine-prednisone (VP) regimen. After the final course of chemotherapy, the patient died of respiratory failure caused by a severe pulmonary fungal infection.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMyelodysplastic neoplasm with SF3B1 mutation (MDS-SF3B1) represents a distinct clinicopathological entity characterized by SF3B1 mutations and typically associated with ring sideroblasts, low blast counts, and a generally favorable prognosis(4). Nonetheless, in rare cases, such as ours, the disease can transform into ALL, particularly of B-cell lineage. Genomic analysis at transformation revealed clonal persistence of SF3B1 p.K700E, alongside acquisition of multiple novel mutations, including GNB1 p.K57N, NF1 p.R1241*, CREBBP compound variants, ATRX p.K307fs, and NFE2 p.P142fs. Notably, JAK2 p.V617F and CBL mutations detected at initial diagnosis were absent at transformation. This can be explained by the fact that MDS is characterized by heterogeneous clonal populations with various driver mutations. During disease progression, clonal evolution often occurs with new subclones emerging that can outcompete the original clones\u0026mdash;a process called \"clone sweeping.\" Mutations in some genes may drive the evolution toward more aggressive disease states(5, 6).\u003c/p\u003e\u003cp\u003eAlthough the role of gene mutations in the transformation of MDS to ALL has not been fully elucidated, investigation of certain newly acquired mutations and their associations with ALL suggests that they may serve as potential drivers of leukemic evolution. ATRX belongs to the switch/sucrose non-fermentable (SWI/SNF) family of chromatin remodeling proteins and plays an essential role in regulating gene expression and maintaining genomic stability. Disturbance of ATRX function can lead to defective sister chromatid cohesion and congression, telomere dysfunction, and aberrant patterns of DNA methylation(7). Adult relapsed B-cell precursor ALL patients have shown a higher likelihood of accumulating mutations in chromatin remodeling factors such as ATRX(8). Existing studies have demonstrated that ATRX is a novel putative driver gene in ALL, associated with relapse or detected in rising clones at relapse. Although the exact mechanisms by which ATRX loss promotes cancer progression remain unclear, all ATRX mutations reported to date are predicted to be deleterious(8).\u003c/p\u003e\u003cp\u003eThe patient demonstrated poor response to standard vindesine-based chemotherapy regimens, achieving only partial remission. The presence of CREBBP mutations may have contributed to chemoresistance. These mutations impair histone acetyltransferase activity and transcriptional coactivator functions, disrupting gene regulation that controls cell proliferation and response to treatment(9, 10). For elderly patients with B-ALL recommend consideration of immunotherapy such as blinatumomab, or CAR-T cells where feasible (11, 12). Unfortunately, our patient\u0026rsquo;s frailty and infectious complications precluded such interventions, ultimately leading to treatment failure and death from fungal pneumonia.\u003c/p\u003e\u003cp\u003eInterestingly, our patient acquired a GNB1 mutation during transformation from MDS to B-ALL. GNB1 mutations have been predominantly reported in myeloid neoplasms(13) and have also been linked to resistance to tyrosine kinase inhibitors in certain leukemias, as they can activate alternative survival pathways such as PI3K/AKT/mTOR and MAPK, thereby enabling leukemic cells to bypass targeted therapy(14). However, its role in lymphoid leukemogenesis remains poorly understood, and reports of GNB1 mutations in B-ALL are exceedingly rare.\u003c/p\u003e\u003cp\u003eAlthough NF1 and NFE2 mutations were detected at the time of transformation, current evidence suggests that their direct association with lymphoid leukemogenesis is relatively weak, and their role in the progression from MDS to ALL remains uncertain.\u003c/p\u003e\u003cp\u003eIn addition to the aforementioned case, our study compiled 55 cases of MDS transforming into ALL from 1980 to 2024 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The majority of these patients were male, accounting for 71.4% of the cohort. The median age at onset for the entire cohort was 56.5 years (interquartile range: 31.75\u0026ndash;69 years). The median time to transformation to ALL was 11 months (interquartile range: 3.5\u0026ndash;32 months). Among the ALL subtypes following transformation, 65.2% were B-ALL, 28.3% were T-ALL, and three cases were classified as biphenotypic ALL. Among the MDS patients with chromosomal abnormalities, the most common abnormality was the deletion of the long arm of chromosome 5, observed in 46.7% (7/15) of cases, and patients with this isolated abnormality were more likely to achieve favorable remission after induction chemotherapy. The overall median survival after transformation was 3 months (interquartile range: 3\u0026ndash;17.25 months). Patients with complex karyotypes at baseline or those who developed complex karyotypes during transformation to ALL exhibited poor prognoses. During the transformation from MDS to ALL, 68% (17/25) of patients acquired new cytogenetic abnormalities, and 68.75% (11/16) of these patients experienced unfavorable outcomes. However, there is currently no conclusive evidence that establishes a direct relationship between chromosomal abnormalities and disease transformation. Poor prognosis was also associated with characteristics such as intolerance to induction chemotherapy, inadequate treatment response, and early relapse post-remission. Consistent with these findings, our patient developed novel mutations at transformation and had limited response to chemotherapy, supporting the view that clonal evolution drives MDS progression to ALL and contributes to dismal outcomes.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e55 cases of MDS transforming into ALL from 1980 to 2024\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge (y)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eChromosomal and molecular abnormalities of MDS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTherapeutic regimen of MDS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTime to transformation (m)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSubtype of ALL\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eChromosomal and molecular abnormalities of ALL\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTreatment Outcome\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eOverall survial after transformation (m)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePyridoxine, folic acid, and vitamin B12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eComplete remission (CR) for 11 months, followed by a relapse and then died\u003c/p\u003e\u003cp\u003e2 weeks later due to extensive bilateral bacterial pneumonia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(15)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePyridoxine, folic acid, and nandrolone decanoate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e47 and 48 chromosomes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCR for 3 months, followed by a relapse and then died in heart failure 6 weeks later\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(16)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eExperienced intracerebral hemorrhage and died\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(17)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46,XX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBlood transfusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46,XX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(18)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePyridoxine and folic acid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eT-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46,XY\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDied from gastrointestinal bleeding\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(19)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSteroids\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBiphenotypic (myeloid and null-cell ALL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46,XY\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePR after 2 courses of treatments, relapsed after 4 months and PR after re-start of treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(20)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e94, XXYY, +\u0026thinsp;13, +13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCR after 4-weeks treatment, replased later, PR after 4-weeks re-start of treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(21)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46,XX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBlood transfusion and\u003c/p\u003e\u003cp\u003eoxymetholone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003epre-B ALL (L1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46,XX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo remission was\u003c/p\u003e\u003cp\u003eobtained and died of sepsis and gastrointestinal\u003c/p\u003e\u003cp\u003ehaemorrhages\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(22)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBlood transfusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDied of pseudomonas sepsis a few days later\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(23)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46,XX t(4;11), (q21;q23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRadiotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e43,XX t(4;11),-3,-5,-7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCR after re-induction\u003c/p\u003e\u003cp\u003echemotherapy, relapsed 3 months later and died of spinal cord\u003c/p\u003e\u003cp\u003ecompression 4 months later\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(24)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBlood transfusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBiphenotypic (B-, T- and myeloid lineage feature)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDied soon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(25)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46,XY\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eaclarubicin and Behenoyl-AraC.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46,XY,t(9:22)(q34:q11)//BCR-ABL(P210)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(26)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eT-ALL (L2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46,XY\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCR for 2 months, then Intracranial relapsed and died of E. coli sepsis with\u003c/p\u003e\u003cp\u003eacute respiratory distress syndrome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(27)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSupportive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003epre-B ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e49,XY,+4,+6,+8,inv(14)(q11q32)[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]/48,X,PY,c4,c6,c8,inv(14)(q11q32)[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]/46,XY[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCR after 1 month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(28)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46,XY\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBlood transfusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46,XY\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(29)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46,XY\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAnabolic steroid and blood transfusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46,XY,t(9;22)(q34;q11),20q\u0026ndash;, 46,XY,20q\u0026ndash;//BCR-ABL(P190)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo remission was\u003c/p\u003e\u003cp\u003eobtained\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(30)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eT-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e48,XY,+8[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] /46,XY [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCR for 15 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(31)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eT-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo remission was\u003c/p\u003e\u003cp\u003eobtained\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(31)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eT-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46,XX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCR for 4.5 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(31)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eT-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e45,XY,-7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo remission was obtained\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(31)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eT-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e47,XY,+8[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]/48,XY,+8,+13[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]/48,XY,+8,+20[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]/46,XY [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCR for 45 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(31)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eT-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46,XY\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCR for 12 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(31)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46,XY,5q-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(32)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCR for 2 years, MDS relapsed with bone marrow fibrosis, and 3 months later, acute megakaryoblastic leukemia developed. The patient died of sepsis.\"\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(33)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBiphenotypic ((AML M5a/T-lineage feature)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46,XY,t(X;9;11)(p21.1;p22;q23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(34)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44,XY,r(11)(p15q23),-der(12;20)t(12;20)(-p13;q11.2)t(12;20)(-q24.3;q11.2),-17,-2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCytosine arabinosidem etoposide, daunomycin, 6-thioguanine, and dexamethasone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePre-B ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e45, XY, -9, -22, +\u0026thinsp;21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eReturn the original RAEB marrow morphology, then died from cytomegalovirus pneumonitis and graft versus host disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(35)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(36)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47,XY,+8[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e47,XY,+8[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]/del(9p),-add(10p)[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eReduction in bone marrow blasts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(37)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45, XY, del(5)(q22q33), -7, add(12)(p13).[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]/46 XY[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHydroxyurea to treat eosinophilia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e45, XY, del(5)(q22q33), -7, add(12) (p13). [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]/46 XY[0]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTolerated induction chemotherapy poorly and died of sepsis and multiorgan failure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(38)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44, X, -Y, der(5)t(5;7)(q13p11), -7, add(12)(p11), del(13)(q12q14)[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]/41, idem, -10, -14, -8, -20, +mar[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]/44, X, -Y, der(5)t(5;12)(q11q13), -7, -12, del(13)(q12q14)\u0026thinsp;+\u0026thinsp;mar[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]/46, XY, t(3;11)(p25q13)[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]/46, XY[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eVitamin D3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB-ALL (L3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e44, X, -Y, der(5)t(5;7)(q13p11), -7, add(12)(p11), del(13)(q12q14)[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]/44, idem, add(3)(q11)[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]/45, idem, add(9)(q11), +\u0026thinsp;12, -add(12), der(14)t(9;14)(q13p11), ins(14;?)(p11;?), +mar1[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]/47, X, -Y, t(8;22)(q24q11), del(13)(q12q14), -19, +\u0026thinsp;21, +mar2[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]/46, X, -Y, t(8;22)(q24q11), del(13)(q12q14), -19, +\u0026thinsp;21, +mar2[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]//c-myc\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCR, morphological remission\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(39)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44,XX,-3,des(5)(q13q31),der(12),del(12)(p11p12), add(12)(q24),-13,del(20)(q11)[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]/43,XX,-3,des(5)(q13q31),der(12),del(12)(p11p12),add(12)(q24),-13,-20[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]/45,XX,-3,del(5)(q13q31),der(12),del(12)(p11p12),add(12)(q24),-13,-20,+21,+22[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]/46,XX[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB-ALL (L3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e45,XX,-3,del(5)(13q31)[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]/43,XX,-3,del(5)(q13q31),-7,der(12),del(12)(p11p12),add(12)(q24),-13,-20[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]/45,XX,-3,del(5)(q13q31),der(12)(p11p12),add(12)(q24),-13,-20,+21,+22[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]/46,XX [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDied of multiorgan failure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(40)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB-ALL (L3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(41)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47,XY,+8[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCyclosporin and blood transfusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePre-B ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e47,XY,+8[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDied of sepsis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(42)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46,XY\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCyclosporine, prednisolone and blood transfusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePre-B ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(43)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBlood transfusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eT-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCR for at least 3 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(44)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBlood transfusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eT-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDied of multiple organ failure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(45)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBlood transfusion and broad spectrum antibiotic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCR for at least 1.5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(46)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47,XY,+Y,del(5)(q13q33)[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]/47,XY,+Y[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLenalidomide\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e47,XY,+Y[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]/47, idem, del(5)(q13q31)[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]/47,XY,+Y,del(20)(q11.2q13)[cp2]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDied soon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(47)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46,XX,del(5)(q13q33)[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLenalidomide and erythropoietin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46,XX,del(5)(q13q33)[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]/46,XX[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]/46,XX,del(5)(q13q33),del(20)(q11.2q13.1)[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDied soon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(47)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46,XX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eErythropoietin and G-CSF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePre-B ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCR for at least 7 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(48)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46,XY,del(5)(q22q35)[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]/46,XY[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTestosterone, erythropoietin, thalidomide, and blood transfusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePre-B ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46,XY,t(3;3)(q21;q26),del(11p)[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]/46,XY,del(5q)[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDied of serious infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(49)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46,XY,del(20)(q11;q13)[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]/46,XY[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThalidomide\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDied of a hemorrhagic stroke\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(50)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46,XX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSupportive treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003edel(13q14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDied of tumor lysis syndrome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(51)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47,XY,+8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAntibiotic therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCR for at least 1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(52)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46,XX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAntibiotic therapy and blood transfusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCR for at least 5 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(52)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45, XX,t(5;9;?)(q13;q12;?),-7,del(12)(p11.2p13),-20,- mar/MLL amplification\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eErythropoietin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eT-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDied of multi-organ failure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(53)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46, XX, del(5)(q13q33)/TP53、TET2 mutation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46, XX, del(5)(q13q33)/TP53、TET2 mutation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCR in 28 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(54)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46, XY\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePre-B ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46,XY/ASXL1 mutation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDied of severe pulmonary infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(55)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46, XY, del(5)(q22q35)/EZH2 mutation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLenalidomide\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46, XY/EZH2 mutation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eAchieved CR in 2 months and maintained for at least 7 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(56)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46, XX [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]/BCOR、DNMT3A、PTPN11、RUNX1 mutation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFirst induction: idarubicin, clofarabine, cytarabine\u003c/p\u003e\u003cp\u003eSecond induction: cytarabine, amsacrine, clofarabine\u003c/p\u003e\u003cp\u003eConsolidation: autologous hematopoietic stem cell transplantation with\u003c/p\u003e\u003cp\u003ebusulfan/cyclophosphamide\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEarly pre-B ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46,XX,t(6;11)(q21;23) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]/46,XX [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]/WT1、DNMT3A、BCOR、PTPN11、RUNX1、STAG2 mutation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(57)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46,XX[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] /CBL、IDH2、JAK2、SRSF2、P95H mutation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIdarubicin, cytosine arabinoside, etoposide\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEarly pre-B ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46, XX, del(9)(p11) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]/46, XX,add(2)(q32-33),i(9)(q10)[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]/46, XX [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]//CBL、IDH2、JAK2、SRSF2 mutation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eUnable to tolerate induction therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(57)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46, XY, del(20)(q11q13) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e];idem,del(5) (q31q34) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]; 46XY [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGlucocorticosteroids and vincristine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eT-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46, XY, del(20)(q11q13) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e];idem,del(5) (q31q34) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]; 46XY [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eUnable to tolerate induction therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(57)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBlood transfusion, erythropoietin, cyclosporin A, stanozolol, and\u003c/p\u003e\u003cp\u003ereconstituted blood platelets\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e47, XY, +\u0026thinsp;21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCR in 1 course of therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(58)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45, X\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eerythropoietin, lenalidomide, and blood transfusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e45, X\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eUnable to tolerate multiple chemotherapy regimens, the patient opted for palliative treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(59)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46, XX, del(1q31.3q32.1)//RUNX1、PHF6、JAX3、CDKN2B mutation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eT-ALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46, XX, del(1q31.3q32.1)//RUNX1、PHF6、JAX3、CDKN2B mutation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eAchieved CR for at least 14 months after hematopoietic stem cell transplantation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(60)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, we report a rare case of MDS with an SF3B1 mutation that subsequently transformed into B-ALL after nearly a decade of disease stability. The transformation was accompanied by clonal persistence of the SF3B1 mutation and the emergence of additional genetic alterations, including GNB1, NF1, CREBBP, ATRX, and NFE2, suggesting that clonal evolution and acquisition of new mutations may play a pivotal role in driving lymphoid leukemic transformation.\u003c/p\u003e\u003cp\u003eOur case highlights the poor prognosis of MDS-derived ALL, characterized by limited response to conventional chemotherapy and high treatment-related mortality. Given the increasing availability of targeted agents and immunotherapies such as blinatumomab and CAR T-cell therapy(11, 12), future management strategies should focus on integrating genomic profiling into risk stratification to optimize therapeutic decision-making. Further studies are warranted to clarify the molecular mechanisms underlying this rare transformation and to establish tailored therapeutic approaches for affected patients\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWriting-original draft preparation, H.Y.D.; writing-review and editing, J.J.; visualization, H.Y.D., J.J.; supervision, W.Y.F., H.Q.L., J.J. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to partcipate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient has consented to the submission of the case report for submission to the journal. Patients signed informed consent regarding publishing their data and photographs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003cbr\u003e\u003c/strong\u003eNo competing interests declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData and materials available on request by emails to the corresponding authors due to privacy/ethical restrictions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ethics Committee of Shaoxing People's Hospital determined that formal ethics approval was not required for this case report, in accordance with institutional policies on single-case retrospective studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate and Consent to Publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for participation in this study and for publication of the case details and any accompanying images.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGreenberg PL, Stone RM, Al-Kali A, Bennett JM, Borate U, Brunner AM, et al. 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Myelodysplastic syndrome transformed into B-lineage acute lymphoblastic leukemia: A case report. World J Clin Cases. 2021;9(19):5191-6.\u003c/li\u003e\n\u003cli\u003eBazinet A, Heath J, Chong AS, Simo-Cheyou ER, Worme S, Rivera Polo B, et al. Common clonal origin of chronic myelomonocytic leukemia and B-cell acute lymphoblastic leukemia in a patient with a germline CHEK2 variant. Cold Spring Harb Mol Case Stud. 2021;7(3).\u003c/li\u003e\n\u003cli\u003eWang CP, Ferreira JE, Placek A, Aguayo-Hiraldo P, Raca G, Wood BL, et al. A de novo germline RUNX1 variant preceding development of concurrent T-lymphoblastic leukemia and myelodysplastic syndrome. Leuk Lymphoma. 2024;65(9):1357-61.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-hematopathology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Journal of Hematopathology](https://link.springer.com/journal/12308)","snPcode":"12308","submissionUrl":"https://submission.springernature.com/new-submission/12308/3","title":"Journal of Hematopathology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"myelodysplastic syndromes, acute lymphoblastic leukemia, leukemia, MDS, ALL","lastPublishedDoi":"10.21203/rs.3.rs-7745943/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7745943/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMyelodysplastic syndromes (MDS) comprise clonal hematopoietic stem cell disorders characterized by heterogeneous clinical manifestations. Approximately 20\u0026ndash;30% of MDS cases progress to acute myeloid leukemia, whereas transformation to acute lymphoblastic leukemia (ALL) is extremely rare. In this report, we present the case of a Chinese male patient who presented with MDS-refractory anemia with ringed sideroblasts, which developed into B-cell ALL. During disease transformation, the patient acquired novel gene mutations. By comparing the gene mutations identified at the initial MDS diagnosis with those observed at the time of transformation to ALL, we aim to elucidate the genetic alterations associated with disease progression. Furthermore, we provide a comprehensive review of 55 MDS cases reported in the literature so far.\u003c/p\u003e","manuscriptTitle":"B-cell Acute Lymphoblastic Leukemia Following Myelodysplastic Syndromes: A Case Report and Literature Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-20 14:30:32","doi":"10.21203/rs.3.rs-7745943/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-18T05:51:03+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-11T21:29:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"30377656211254422564140035121686553614","date":"2025-10-15T06:56:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-08T04:52:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-02T22:18:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-02T22:18:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Hematopathology","date":"2025-09-30T01:11:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-hematopathology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Journal of Hematopathology](https://link.springer.com/journal/12308)","snPcode":"12308","submissionUrl":"https://submission.springernature.com/new-submission/12308/3","title":"Journal of Hematopathology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"9e8a8d96-39f5-42d7-9af6-edd8f1bfe609","owner":[],"postedDate":"October 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T14:54:23+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-20 14:30:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7745943","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7745943","identity":"rs-7745943","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}