Subjects:
BloodWork, Free Research Articles, Immunobiology and Immunotherapy, Transplantation
A 9-year-old boy, who was treated with hematopoietic stem cell transplant (HSCT) for mixed-phenotype acute leukemia of T-cell and myeloid components with mutations of FLT3-ITD, WT1, and RUNX1, presented. Two months post-HSCT, the patient developed ongoing nausea and vomiting, after which a diagnosis of graft-versus-host disease (GVHD) was confirmed in the gastrointestinal tract. Cerebrospinal fluid (CSF) analysis, as part of the GVHD workup, revealed an unusual increase in the number of nucleated cells (33 × 106/L), of which 82% were mature lymphocytes (panels A-B; original magnification ×50 [A], ×100 [B]; Wright-Giemsa stain). Flow cytometry analysis of the CSF demonstrated a population of natural killer (NK) cells identified by the expression of CD56 (panels C-F, red population). Normal T lymphocytes are highlighted in blue. Both NK cells and T lymphocytes expressed CD2 and CD7. Surface CD3 and CD5 were negative in the NK cells and positive in the normal T lymphocytes (panels C-F). CD34 was negative in both populations, and CD56 was not expressed by the patient’s blast cells at diagnosis, excluding the possibility of CNS relapse.
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A 9-year-old boy, who was treated with hematopoietic stem cell transplant (HSCT) for mixed-phenotype acute leukemia of T-cell and myeloid components with mutations of FLT3-ITD, WT1, and RUNX1, presented. Two months post-HSCT, the patient developed ongoing nausea and vomiting, after which a diagnosis of graft-versus-host disease (GVHD) was confirmed in the gastrointestinal tract. Cerebrospinal fluid (CSF) analysis, as part of the GVHD workup, revealed an unusual increase in the number of nucleated cells (33 × 106/L), of which 82% were mature lymphocytes (panels A-B; original magnification ×50 [A], ×100 [B]; Wright-Giemsa stain). Flow cytometry analysis of the CSF demonstrated a population of natural killer (NK) cells identified by the expression of CD56 (panels C-F, red population). Normal T lymphocytes are highlighted in blue. Both NK cells and T lymphocytes expressed CD2 and CD7. Surface CD3 and CD5 were negative in the NK cells and positive in the normal T lymphocytes (panels C-F). CD34 was negative in both populations, and CD56 was not expressed by the patient’s blast cells at diagnosis, excluding the possibility of CNS relapse.

These findings highlight an interesting phenomenon that is not usually seen in CSFs of leukemia patients.

A 9-year-old boy, who was treated with hematopoietic stem cell transplant (HSCT) for mixed-phenotype acute leukemia of T-cell and myeloid components with mutations of FLT3-ITD, WT1, and RUNX1, presented. Two months post-HSCT, the patient developed ongoing nausea and vomiting, after which a diagnosis of graft-versus-host disease (GVHD) was confirmed in the gastrointestinal tract. Cerebrospinal fluid (CSF) analysis, as part of the GVHD workup, revealed an unusual increase in the number of nucleated cells (33 × 106/L), of which 82% were mature lymphocytes (panels A-B; original magnification ×50 [A], ×100 [B]; Wright-Giemsa stain). Flow cytometry analysis of the CSF demonstrated a population of natural killer (NK) cells identified by the expression of CD56 (panels C-F, red population). Normal T lymphocytes are highlighted in blue. Both NK cells and T lymphocytes expressed CD2 and CD7. Surface CD3 and CD5 were negative in the NK cells and positive in the normal T lymphocytes (panels C-F). CD34 was negative in both populations, and CD56 was not expressed by the patient’s blast cells at diagnosis, excluding the possibility of CNS relapse.
View largeDownload PPT

A 9-year-old boy, who was treated with hematopoietic stem cell transplant (HSCT) for mixed-phenotype acute leukemia of T-cell and myeloid components with mutations of FLT3-ITD, WT1, and RUNX1, presented. Two months post-HSCT, the patient developed ongoing nausea and vomiting, after which a diagnosis of graft-versus-host disease (GVHD) was confirmed in the gastrointestinal tract. Cerebrospinal fluid (CSF) analysis, as part of the GVHD workup, revealed an unusual increase in the number of nucleated cells (33 × 106/L), of which 82% were mature lymphocytes (panels A-B; original magnification ×50 [A], ×100 [B]; Wright-Giemsa stain). Flow cytometry analysis of the CSF demonstrated a population of natural killer (NK) cells identified by the expression of CD56 (panels C-F, red population). Normal T lymphocytes are highlighted in blue. Both NK cells and T lymphocytes expressed CD2 and CD7. Surface CD3 and CD5 were negative in the NK cells and positive in the normal T lymphocytes (panels C-F). CD34 was negative in both populations, and CD56 was not expressed by the patient’s blast cells at diagnosis, excluding the possibility of CNS relapse.

These findings highlight an interesting phenomenon that is not usually seen in CSFs of leukemia patients.

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