Published online Jul 6, 2021. doi: 10.12998/wjcc.v9.i19.5191
Peer-review started: December 13, 2020
First decision: March 27, 2021
Revised: April 6, 2021
Accepted: May 8, 2021
Article in press: May 8, 2021
Published online: July 6, 2021
Processing time: 188 Days and 21.3 Hours
Myelodysplastic syndromes (MDSs) are a group of hematological diseases caused by expansion of an abnormal clone of hematopoietic stem cells. Primary MDS is a potentially premalignant clonal disorder that may progress to overt acute leukemia in 25%-50% of cases. However, most of these cases evolve into acute myeloid leukemia and rarely progress to acute lymphoblastic leukemia (ALL). Thus, transformation of MDS into B-cell ALL is rare.
A 58-year-old man was admitted to the hospital for reduced blood cell counts. Based on all the test results and the World Health Organization diagnosis and classification, the patient was finally diagnosed with ring-shaped sideroblastic MDS with refractory hemocytopenia due to multilineage dysplasia. We used red blood cell transfusions and other symptomatic support treatments. After 4 years, the patient felt dizziness, fatigue, and night sweats. We improved bone marrow and peripheral blood and other related auxiliary examinations. He was eventually diagnosed with B-lineage acute lymphocytic leukemia (MDS transformation).
The number of peripheral blood cells, type of MDS, proportion of primitive cells in bone marrow, and number and quality of karyotypes are all closely related to the conversion of MDS to ALL.
Core Tip: We present a case of ring-shaped sideroblastic myelodysplastic syndrome, with refractory hemocytopenia due to multi-lineage dysplasia, that was transformed into B-cell acute lymphoblastic leukemia. Even though the lymphoid progression in myelodysplastic syndrome has been reported previously, most displayed myeloid-lymphoid hybrid, B cell acute lymphoblastic leukemia is rarely reported, and the specific mechanism is still unclear. We report a rare lymphoid transformation in order to provide information for the study of specific mechanism, and help doctors to provide appropriate treatment to patients.