case_images: PMC10723836_01
case_images: (A) Morphology of the patient's lymphoblasts (scale: 10x). (B) Results of flow cytometry analysis. (C) Treatment flow chart. (D) Drugs with a relative inhibition rate higher than 50%. (E) MRD values during the treatment period.
case_images: fonc-13-1291570-g001.jpg
case_images: PMC10723836_01_fonc-13-1291570-g001.jpg
case_images: f1
case_images: Predominance of prolymphocytes (78.2%) among total lymphoid cells indicated L2-type ALL in this patient ( Figure 1A ). Immunophenotyping via flow cytometry indicated that the blasts were mainly CD45min, positive for CD34, CD10, CD19, CD58, CD81, cCD79a, cTdT, and HLA-DR; partially positive for CD13, CD22, CD38, and cIgM; and negative for CD7, CD117, CD33, CD9, CD56, CD20, CD79b, and MPO, indicating a diagnosis of acute B lymphoblastic leukemia (B-ALL) ( Figure 1B ). Chemotherapy schemes were conducted as shown in  Figure 1C . The patient received two additional rounds of induction therapy but was still minimal residual disease (MRD) and SSBP2-CSF1R positive, as detailed in  Figure 1E . Figure 1D . Finally, the patient received a regimen including cytarabine 156 mg/m2, days 1-5; homoharringtonine 3 mg/m2, days 1- 5, dexamethasone 7.8 mg/m2, days 1-7; fludarabine 25 mg/m2, days 1-5; vindesine 3 mg/m2, days 1 and 8; and epirubicin 30 mg/m2, day 8; and ultimately achieved complete remission both at the cellular level (MRD negative) and at the gene level (SSBP2-CSF1R negative).