• Elena-Cristina Marinescu, Horia Bumbea, Iuliana Iordan, Ion Dumitru, Dan Soare, Cristina Ciufu, and Mihaela Gaman.
• Department of Methodology and Scientific Research, "Carol Davila" University of Medicine and Pharmacy, Eroilor Sanitari Boulevard, No. 8, 050474 Bucharest, Romania.
• Medicina (Kaunas). 2023 Mar 28; 59 (4).

AbstractRelapsed acute lymphoblastic leukemia (ALL) represents a continuous challenge for the clinician. Despite recent advances in treatment, the risk of relapse remains significant. The clinical, biological, cytogenetic, and molecular characteristics may be different at the time of relapse. Current comprehensive genome sequencing studies suggest that most relapsed patients, especially those with late relapses, acquire new genetic abnormalities, usually within a minor clone that emerges after ALL diagnosis. We report the case of a 23-year-old young woman diagnosed with Philadelphia chromosome-negative B cell acute lymphoblastic leukemia. The patient underwent allogeneic stem cell transplantation (allo-HSCT) after complete remission. Despite having favorable prognostic factors at diagnosis, the disease relapsed early after allo-HSCT. The cytogenetic and molecular exams at relapse were positive for the Philadelphia chromosome, respectively for the Bcr-Abl transcript. What exactly led to the recurrence of this disease in a more aggressive cytogenetic and molecular form, although there were no predictive elements at diagnosis?

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