Acute lymphoblastic leukemia with the (8;14)(q24;q32) translocation and FAB L3 morphology associated with a E-precursor immunophenotype: the Pediatric Oncology Group experience

Five pediatric patients are described with acute lymphoblastic leukemia (AL L) who at presentation had clinical findings suggestive of B cell ALL and l ymphoblasts with FAB L3 morphology and the characteristic t(8;14)(q24;q32). However, the leukemia cells of all five patients failed to express surface immunoglobulin (slg) and kappa or lambda light chains. Based on initial im munophenotyping results consistent with B-precursor ALL, four of these case s were initially treated with conventional ALL chemotherapy. These four pat ients were switched to B cell ALL treatment protocols once cytogenetic resu lts became available revealing the 8;14 translocation. The fifth case was t reated with B cell ALL therapy from the outset. Four of the five patients a re in complete remission at 64, 36, 29 and 13 months from diagnosis. One pa tient relapsed and died 6 months after initial presentation. These five unu sual cases with clinical B cell ALL, the t(8;14), and FAB L3 morphology, bu t negative sig, demonstrate the importance of careful and multidisciplinary evaluation of leukemic cells with morphology, cytochemistry, immunophenoty ping and cytogenetic analysis. Future identification of patients with this profile will allow us to expand our knowledge regarding prognostic signific ance and optimal treatment for this rare subgroup of patients.