{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T10:37:15Z","timestamp":1773657435292,"version":"3.50.1"},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"vor","delay-in-days":327,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Hematology"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>Blinatumomab is a promising monoclonal antibody therapeutic for the treatment of relapsed or refractory B\u2010cell precursor acute lymphoblastic leukemia (B\u2010ALL). However, it has been associated with lineage switch in acute leukemia, particularly in cases of KMT2A\u2010rearranged B\u2010ALL, which carries a poor prognosis. While most lineage switch events present as acute myeloid leukemia (AML), rare cases may manifest as myeloid sarcoma. In the current report, we describe the development of myeloid sarcoma following blinatumomab treatment in a patient with refractory KMT2A\u2010rearranged B\u2010ALL. The patient, a 19\u2010year\u2010old African American male with primary Philadelphia chromosome\u2010negative B\u2010ALL, was initially treated with a pediatric\u2010inspired chemotherapy regimen. He achieved pathologically morphologic remission after induction, but his minimal residual disease (MRD) testing remained persistently positive, eventually progressing to bone marrow relapse. The patient was then started on blinatumomab therapy, achieving a second morphological remission; however, his MRD remained detectable. During the fourth cycle of blinatumomab, the patient developed back pain and lower extremity weakness. Imaging revealed an extradural mass in the thoracic spine, resulting in spinal cord compression. Histopathologic evaluation of the mass confirmed a diagnosis of mixed\u2010phenotype myeloid sarcoma harboring the same KMT2A rearrangement. Concurrent bone marrow biopsy revealed mixed\u2010phenotype acute leukemia. The patient was subsequently lost to follow\u2010up. This is the fourth reported case of myeloid sarcoma following blinatumomab therapy of persistent B\u2010ALL. It highlights an unusual and serious pattern of relapse in an extramedullary site following blinatumomab therapy. Clinicians should remain vigilant for signs of lineage switch and extramedullary disease during treatment, particularly in patients with KMT2A\u2010rearranged B\u2010ALL, and consider imaging or biopsy when new neurologic or systemic symptoms arise.<\/jats:p>","DOI":"10.1155\/crh\/7063561","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T04:38:15Z","timestamp":1764045495000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Blinatumomab\u2010Related Lineage Switch of KMT2A\/AFF1\u2010Rearranged B\u2010Lymphoblastic Leukemia to B\/Myeloid Mixed\u2010Phenotype Acute Leukemia and Myeloid Sarcoma Causing Spinal Cord Compression"],"prefix":"10.1155","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5266-6504","authenticated-orcid":false,"given":"Xiaoming","family":"Fan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ankita","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1274-232X","authenticated-orcid":false,"given":"Dominik","family":"Dabrowski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirza","family":"Rusella","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qihui J.","family":"Zhai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5824-867X","authenticated-orcid":false,"given":"Eric X.","family":"Wei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,24]]},"reference":[{"key":"e_1_2_10_1_2","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa2214171"},{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1515\/med-2022-0521"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2018018093"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2023.283705"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-022-01620-2"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2016.09.010"},{"key":"e_1_2_10_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/79.3.387"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.112218799"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/cyto.b.20451"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2021004580"},{"key":"e_1_2_10_11_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2006-10-051912"},{"key":"e_1_2_10_12_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2017-05-783852"},{"key":"e_1_2_10_13_2","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2017.213"},{"key":"e_1_2_10_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqx055"},{"key":"e_1_2_10_15_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.v64.3.701.bloodjournal643701"},{"key":"e_1_2_10_16_2","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.799982"},{"key":"e_1_2_10_17_2","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/7394619"},{"key":"e_1_2_10_18_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2015-08-665547"},{"key":"e_1_2_10_19_2","doi-asserted-by":"publisher","DOI":"10.3390\/reports2030018"},{"key":"e_1_2_10_20_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2022017645"},{"key":"e_1_2_10_21_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2021013442"},{"key":"e_1_2_10_22_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-022-01720-7"},{"key":"e_1_2_10_23_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2021015036"},{"key":"e_1_2_10_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.exphem.2025.105247"},{"key":"e_1_2_10_25_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24783"},{"key":"e_1_2_10_26_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms23074019"},{"key":"e_1_2_10_27_2","first-page":"469","article-title":"Bluetongue and Related Orbivirus Diagnosis in the United States","volume":"178","author":"Pearson J. 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