Acute B-cell lymphoblastic leukemia in a child with severe hemophilia A: A therapeutic challenge in a resource-limited setting

Severe hemophilia A complicated by acute lymphoblastic leukemia (ALL) is exceptionally uncommon and poses significant therapeutic challenges because chemotherapy-induced thrombocytopenia further increases bleeding risk. We report a 1-year-old boy with severe hemophilia A on factor VIII prophylaxis who developed common ALL antigen-positive precursor B-cell ALL. Diagnostic and therapeutic procedures were successfully performed with regular prophylaxis, peri-procedural factor VIII concentrate replacement, and close inhibitor surveillance. The child completed induction and consolidation according to the Berlin-Frankfurt-Munster-2002 protocol and remains in remission without major bleeding episodes. This case highlights how meticulous planning enables successful leukemia treatment in children with severe hemophilia A.