{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T12:16:48Z","timestamp":1756383408484,"version":"3.44.0"},"reference-count":16,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T00:00:00Z","timestamp":1737417600000},"content-version":"unspecified","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,12,17]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>BCR::ABL1-like B-lymphoblastic leukaemia (B-ALL) neoplasms lack the BCR::ABL1 translocation but have a gene expression profile like BCR::ABL1 positive B-ALL. This includes alterations in cytokine receptors and signalling genes, such as <jats:italic>CRLF2, ABL1, ABL2, JAK2, PDGFRB<\/jats:italic> and <jats:italic>EPOR<\/jats:italic>. Cases with CRLF2 rearrangements account for approximately 50% of cases of Philadelphia-like acute lymphoblastic leukaemia (Ph-like ALL), and the frequency of specific genomic lesions varies with ethnicity such that IGH::CRLF2 translocations are more common in Hispanics and Native Americans.<\/jats:p>\n               <jats:p>We report two cases of BCR::ABL1-like ALL, with significant eosinophilia. A Hispanic man in his early 20s and a Hispanic woman in her 50s presented with leukocytosis and eosinophilia. Bone marrow flow cytometry revealed lymphoblasts expressing CD19, CD10, partial CD20, CD22, CD79a, CD38, CD34, TdT and HLA-DR. Examination of the bone marrow biopsy and aspirate exhibited a hypercellular bone marrow with increased blasts and elevated eosinophils. Fluorescence in situ hybridisation (FISH) demonstrated a cryptic chromosomal rearrangement between the X chromosome and chromosome 14 at breakpoints involving IGH at 14q32 and CRLF2 at Xp22.33, t(X;14)(p22.33; q32).<\/jats:p>\n               <jats:p>These findings confirmed the diagnosis of BCR::ABL1-like B-ALL with IGH::CRLF2 rearrangement. One patient (man) attained complete remission with induction therapy using the paediatric CALGB 10403 protocol, while the other patient (woman) had a poor outcome after receiving a hyper-fractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone regimen. These two cases demonstrate an unusual presentation of BCR::ABL1-like B-ALL and emphasise the importance of appropriate cytogenetic studies for correct diagnosis. When treated with conventional chemotherapy, these cases carry a poor prognosis and might require allogeneic transplantation.<\/jats:p>","DOI":"10.1136\/bcr-2024-259811","type":"journal-article","created":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T23:45:15Z","timestamp":1737503115000},"page":"e259811","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cryptic to conventional cytogenetics: Philadelphia-like ALL presenting with hypereosinophilia"],"prefix":"10.1136","volume":"18","author":[{"given":"Zena","family":"Chahine","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonard","family":"Yenwong Fai","sequence":"additional","affiliation":[{"name":"University of Kentucky Medical Center, Lexington, Kentucky, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sainan","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayman","family":"Qasrawi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,1,21]]},"reference":[{"key":"2025082804405001000_18.1.e259811.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(08)70339-5"},{"key":"2025082804405001000_18.1.e259811.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1403088"},{"key":"2025082804405001000_18.1.e259811.3","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2016.159988"},{"key":"2025082804405001000_18.1.e259811.4","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2014.229"},{"key":"2025082804405001000_18.1.e259811.5","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2009.253"},{"key":"2025082804405001000_18.1.e259811.6","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2009.262"},{"key":"2025082804405001000_18.1.e259811.7","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2014.117424"},{"key":"2025082804405001000_18.1.e259811.8","doi-asserted-by":"publisher","DOI":"10.1182\/asheducation-2018.1.137"},{"key":"2025082804405001000_18.1.e259811.9","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.55.4105"},{"key":"2025082804405001000_18.1.e259811.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccr.2012.06.005"},{"key":"2025082804405001000_18.1.e259811.11","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.69.0073"},{"key":"2025082804405001000_18.1.e259811.12","doi-asserted-by":"publisher","DOI":"10.1002\/gcc.22439"},{"key":"2025082804405001000_18.1.e259811.13","doi-asserted-by":"publisher","DOI":"10.1038\/ng.469"},{"key":"2025082804405001000_18.1.e259811.14","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2009-09-245944"},{"key":"2025082804405001000_18.1.e259811.15","doi-asserted-by":"crossref","first-page":"2399","DOI":"10.1038\/s41375-021-01133-4","article-title":"Increased Incidence of IKZF1 deletions and IGH-CRLF2 translocations in B-ALL of Hispanic\/Latino children-a novel health disparity","volume":"35","author":"Raca","year":"2021","journal-title":"Leukemia"},{"key":"2025082804405001000_18.1.e259811.16","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-07-726588"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-259811","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T11:40:59Z","timestamp":1756381259000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-259811"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,21]]},"published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1136\/bcr-2024-259811"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-259811","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}