To the editor: A 69-year-old man presents with cough and SOB approximately 3.5 years following diagnosis of a poorly differentiated acute lymphocytic leukemia (progenitor cell phenotype). By flow cytometry, the initial leukemia in 1998 was positive for HLA-DR, CD34, and CD45 and negative for lymphoid and myeloid markers including: CD3, CD5, CD7, CD19, CD10, CD20, CD13, CD33, CD11b, and CD14; CD1a and S-100 protein staining were not available on this sample. A pathologic diagnosis of a progenitor cell leukemia most suggestive of acute lymphocytic leukemia was made. The patient received induction therapy in November 1998 and achieved a complete remission. Consolidation therapy was discontinued after one cycle due to severe cytopenias. Maintenance therapy was discontinued after 6 months secondary to methotrexate-induced hepatoxicity.
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Hirsh et al. (2009) studied this question.