{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T12:51:34Z","timestamp":1761742294713},"reference-count":38,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2003,12,15]],"date-time":"2003-12-15T00:00:00Z","timestamp":1071446400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2004,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Complicating malignant hematopoietic proliferations might severely hamper the course of acute lymphoblastic leukemia (ALL) in patients with an otherwise good prognosis. It is important to distinguish whether such neoplastic proliferations represent ALL relapses or secondary treatment\u2010related malignancies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>We present an 11\u2010year\u2010old girl with precursor\u2010B\u2010ALL in whom maintenance treatment was complicated by an isolated ALL relapse in the brain, nodular lymphoproliferations in the liver, and an isolated myelo\u2010monocytic leukemia cutis. All these hemato\u2010oncologic malignancies occurred in the background of a secondary immunodeficiency, most likely caused by cytotoxic treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results and Conclusions<\/jats:title><jats:p>Using a stepwise molecular approach, we were able to demonstrate that the liver infiltrates were Epstein\u2013Barr virus (EBV)\u2010positive, contained monoclonal mature B\u2010cells with immunoglobulin heavy chain gene (<jats:italic>IGH<\/jats:italic>) gene rearrangements unrelated to the primary ALL, and thus represented a true secondary non\u2010Hodgkin lymphoma (NHL). In contrast, the skin infiltrates consisted of myelo\u2010monocytic cells with clonal <jats:italic>IGH<\/jats:italic> and T\u2010cell receptor gamma gene rearrangements, identical to the precursor\u2010B\u2010ALL blasts at diagnosis. Thus, the disease course of the precursor\u2010B\u2010ALL patient was complicated by two different isolated extramedullary relapses (brain and skin) and a secondary EBV<jats:sup>+<\/jats:sup> B\u2010NHL. \u00a9 2003 Wiley\u2010Liss, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.10466","type":"journal-article","created":{"date-parts":[[2004,2,11]],"date-time":"2004-02-11T09:00:52Z","timestamp":1076490052000},"page":"343-349","source":"Crossref","is-referenced-by-count":10,"title":["Acute lymphoblastic leukemia followed by a clonally\u2010unrelated EBV\u2010positive non\u2010Hodgkin lymphoma and a clonally\u2010related myelomonocytic leukemia cutis"],"prefix":"10.1002","volume":"42","author":[{"given":"Tomasz","family":"Szczepa\u0144ski","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerard A.M.","family":"de 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