Dear Anna, The original diagnosis was obviously a T-ALL. CD1 and other myeloid marker were probably negative. The leukemia showed a partial tendency of maturation. At time of relapse there might be a selection (caused by therapy) of the most immature cell close to the branching cell of myelo- and lymphopoiesis. The alternative explanation is the occurance of a new chromosomal abberation under therapy. The first theory (selection) is more common in AML, the latter I prefer. Cytogenetics should provide the answer. AML should be myeloperoxidase positive (+ CD117, CD33 or CDw65) and a secondary, therapy induced AML should appear later after end of therapy. Best regards Thomas Nebe Klinikum Mannheim
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