B-acute lymphoblastic leukemia/lymphoma (B-ALL) with precedent or concurrent myelodysplastic syndrome (MDS) with deletion 5q

Progression to acute leukemia is an inherited feature of myelodysplastic syndrome (MDS). While majority of acute leukemia cases in this setting is acute myeloid leukemia (AML), rare cases of acute B-lymphoblastic leukemia/lymphoma (B-ALL) also exist. Therefore, detection of increased blasts in a patient with MDS should not be equated with a diagnosis of AML; full immunophenotyping of blasts is required. Previous reports indicate that dysplastic myeloid cells and B-lymphoblasts belong to the same clone. However, dysplastic myeloid cells and B-lymphoblasts could be clonally unrelated. Decitabine in addition to hyperCVAD (fractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone alternating with high-dose methotrexate and cytarabine) could be a good treatment option in this particular clinical setting.