Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski, Gospodin Iliev
ISSN: 1312 773X (Online)
Issue: 2015, vol. 21, issue 2
Subject Area: Medicine - Hematology
Pages: 767-769
DOI: 10.5272/jimab.2015212.767
Published online: 09 April 2015

J of IMAB 2015 Apr-Jun;21(2):767-769
Vanya Slavcheva1Corresponding Autor, Kalina Ignatova2, Stanislava Panayotova1, Nikolai Tzvetkov1, Vasil Todorov3.
1) Clinic of Hematology, University Hospital, Pleven, Bulgaria.
2) National Specialized Hospital for Active Treatment of Hematological Diseases, Sofia, Bulgaria.
3) Clinic of Nephrology, University Hospital, Pleven, Bulgaria.

Acute lymphoblastic leukemia is a disease, which is more common in children. We report a clinical case of a patient aged 25. Thirty-two months before his last admission in Hematology clinic, acute pre- B lymphoblastic leukemia had been diagnosed and treated till March 2012.
In September 2013 after bone marrow aspiration, flow cytometric analysis, trepan biopsy and biopsy of the kidney had been carried out, the patient was diagnosed with first late relapse, involving bone marrow and kidney. A second remission was achieved using Berlin- Frankfurt– Munster chemotherapy [BFM] and allogenic stem cell transplantation was performed.

Key words: leukemia, relapse, polycythemia, kidney,

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Please cite this article in PubMed Style or AMA (American Medical Association) Style:
Slavcheva V, Ignatova K, Panayotova S, Tzvetkov N, Todorov V. Unusual clinical presentation of relapse in patient with Acute Lymphoblastic Leukemia. J of IMAB. 2015 Jan-Mar;21(2):767-769. doi:

Correspondence to: Vanya Slavcheva, MD; Clinic of Hematology, University Hospital Pleven; 8 A, Georgi Kochev blvd., 5800 Pleven, Bulgaria; E-mail:

1. Faderl S, Kantarjian MH, Talpaz M, Estrov Z. Clinical Significance of cytogenetic abnormalities in adult acute lymphoblastic leukemia. Blood. 1998 Jun 1;91(11):3995-4019. [PubMed]
2. Provan D, Singer CRJ, Baglin T, Lilleyman J. Acute Lymphoblastic Leukemia. Oxford Handbook of Clinical Haematology. 2nd edition. 2004, 158-163.
3. Thomas X, Olteanu N, Charrin C, Lheritier V, Magaud JP, Fiere D. Acute Lymphoblastic Leukemia in the Elderly: The Edouard Herriot Hospital Experience. Am J Hematol. 2001 Jun;67(2):73–83. [PubMed]
4. Nguyen K, Devidas M, Cheng S-C, La M, Raetz EA, Carroll WL, et al. Factors influencing survival after  relapse from acute lymphoblastic leukemia: a Children's Oncology Group study. Leukemia 2008 Dec;22(12):2142–2150. [PubMed] [CrossRef]
5. Locatelli F, Schrappe М, Bernardo ME, Rutella S. How I treat relapsed childhood acute lymphoblastic leukemia. Blood. 2012; Oct 4;120 (14):2807-16 [PubMed] [CrossRef]
6. Kebaili K, Manel AM, Chapelon C, Taylor P, Philippe N, Bertrand Y. Renal enlargement as presentation of isolated renal relapse in childhood leukemia. J Pediatr Hematol Oncol. 2000 Sep-Oct;22(5):454-456. [PubMed]
7. Skeith L, Lazo-Langner A, Mangel J. Kidney and Pancreatic Extramedullary Relapse in Adult Acute Lymphoblastic Leukemia: A Case Report and Review of the Literature. Case Reports in Hematology. Hindawi. Vol 2013 (2013), ID 637264. [CrossRef]
8. Jonasan E, Christopher G, Michael B. Atkins. Renal neoplasia. Brenner: Brenner and Rector's The Kidney, 8th ed. 2007, 1350-1367
9. Faderl S, Do K-A, Johnson MM, Keating M, O’Brien S, Jilani I, et al. Angiogenic factors may have a different prognostic role in adult acute lymphoblastic leukemia. Blood. 2005 Dec 25;106(13):4303-7. [CrossRef]
10. Crazzolara R, Kreczy A, Mann G, Heitger A, Eibl G, Fink F-M, et al. High expression of the chemokine receptor CXCR4 predicts extramedullary organ infiltration in childhood acute lymphoblastic leukaemia. B J Haematol. 2001 Dec;115(3):545-553. [PubMed] [CrossRef]
11. Juarez J, Dela Pena A, Baraz R, Hewson J, Khoo M, Cisterne A, et al. CXCR4 antagonists mobilize childhood acute lymphoblastic leukemia cells into the peripheral blood and inhibit engraftment. Leukemia. 2007 Jun;21(6):1249–1257. [PubMed] [CrossRef]
12. Teicher BA, Fricker SP. CXCL12 (SDF-1)/CXCR4 pathway in Cancer. Clin Cancer Res. 2010 Jun 1;16(11); 2927–31. [PubMed] [CrossRef]
13. Murdoch C. CXCR4: chemokine receptor extraordinaire. Immunol Rev. 2000 Oct;177(1):175-84. [PubMed] [CrossRef]
14. Kucia M, Reca R, Miekus K, Wanzeck J, Wojakowski W, Janowska-Wieczorek A, et al. Trafficking of normal stem cells and metastasis of cancer stem cells involve similar mechanisms: pivotal role of the SDF-1-CXCR4 axis. Stem Cells. 2005 Aug;23(7):879-94. [PubMed] [CrossRef]
15. Busilloa JM, Benovica JL. Regulation of CXCR4 Signaling. Biochim Biophys Acta. 2007 Apr;1768(4):952–963. [PubMed] [CrossRef]
16. Kakinuma T, Hwang ST. Chemokines, chemokine receptors, and cancer metastasis. J Leukoc Biol. 2006 Apr;79(4):639-651. [PubMed] [CrossRef]
17. Rankin EB, Giaccia AJ. The role of hypoxia-inducible factors in tumorigenesis. Cell Death Differ. 2008 Apr;15(4):678–685. [PubMed] [CrossRef]
18. Osumi T, Awazu M, Fujimura E, Yamazaki F, Hashiguchi A, Shimada H. Leukemia kidney infiltration can cause secondary polycythemia by activating hypoxia-inducible factor (HIF) pathway. Eur J Pediatr. 2013 Jun;172(6):829-32. [PubMed] [CrossRef].

Received: 21 January 2015
Published online: 09 April 2015

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