Successful allogeneic hematopoietic stem cell transplantation for aleukemic Philadelphia chromosome-positive acute lymphoblastic leukemia secondary to chemo-radiotherapy for breast cancer

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 Aleukemic and tumor-forming Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph⁺ ALL) is very rare. A 54-year-old woman with a medical history of chemo-radiotherapy for breast cancer was admitted because of the right side pleural effusion and possible malignant lymphoma of the right supraclavicular lymph node. Positron emission tomography showed the accumulation at the right pleura, mesenteric lymph nodes, and the left iliac bone. WBC and its differential counts were normal, and the anemia and thrombocytopenia were not noted. A bone marrow aspirate showed abundant blasts of immature B cell lineage, and the karyotype was a complex karyotype including t (9 ; 22). PCR examination demonstrated minor bcr-abl transcript. In the pleural effusion, small number of blasts with the same phenotype was observed. Immunopathologic re-examination of the biopsied lymph mode revealed to be lymphoblastic lymphoma with the same phenotype of morrow blasts. A diagnosis of aleukemic and tumor-forming Ph⁺ ALL was made. She was treated with 2courses of Hyper-CVAD with dasatinib with disappearance of minor bcr-abl transcript from the bone marrow and pleural effusion. We performed allogeneic peripheral blood hematopoietic stem cell transplantation from an HLA-matched sibling with uneventful engraftment. One year after the transplantation, she is maintaining remission with mild skin GVHD.