{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T05:13:49Z","timestamp":1783660429943,"version":"3.55.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>B-cell malignancies comprise a biologically diverse group of neoplasms, with only rare reports describing the co-occurrence of two distinct lymphoid entities. While concurrent presentation of mature B-cell neoplasms has been documented, the simultaneous occurrence of B-cell acute lymphoblastic leukemia (B-ALL) and plasma cell neoplasm (PCN) has previously been reported rarely. Such cases may provide insight into the clonal architecture and evolutionary pathways underlying lymphoid malignancies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report a 76-year-old man presenting with cytopenias and leukocytosis, in whom initial bone marrow evaluation and immunophenotyping established a diagnosis of B-ALL with a pre-B phenotype. At the time of diagnosis, flow cytometry also identified a distinct population of aberrant plasma cells, raising the possibility of a concurrent plasma cell neoplasm. Follow-up bone marrow analysis confirmed the coexistence of two immunophenotypically and morphologically distinct malignant populations: immature lymphoblasts consistent with B-ALL and clonal plasma cells. Initial ALL-directed therapy induced remission of both components. However, subsequent disease evolution demonstrated a clear phenotypic shift, with relapse characterized by expansion of a plasmablastic\/plasma cell population consistent with PCN, while the B-ALL component remained undetectable by minimal residual disease assessment. Treatment was therefore redirected toward a myeloma-based regimen, which was limited by toxicity and failed to achieve disease control. Genomic analysis supported the presence of two clonally related but distinct malignancies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings support a model of early clonal divergence from a common progenitor rather than independent malignancies or linear differentiation. This case highlights the complexity of clonal evolution in B-cell malignancies and underscores the importance of integrated genomic and immunophenotypic analysis in understanding disease biology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1886626","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T04:24:25Z","timestamp":1783657465000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Concurrent B-cell acute lymphoblastic leukemia and plasma cell neoplasm with plasmablastic features supporting divergent evolution from a shared precursor: a case report"],"prefix":"10.3389","volume":"16","author":[{"given":"Antonija","family":"Babi\u0107","sequence":"first","affiliation":[{"name":"Department of Laboratory Immunology, Clinical Department of Laboratory Diagnostics, University Hospital Centre Zagreb","place":["Zagreb, Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana","family":"Frani\u0107 \u0160imi\u0107","sequence":"additional","affiliation":[{"name":"Department of Cytogenetics, Clinical Department of Laboratory Diagnostics, University Hospital Centre Zagreb","place":["Zagreb, Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josip","family":"Kne\u017eevi\u0107","sequence":"additional","affiliation":[{"name":"Department of Laboratory Immunology, Clinical Department of Laboratory Diagnostics, University Hospital Centre Zagreb","place":["Zagreb, Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koraljka","family":"Gjadrov Kuve\u017edi\u0107","sequence":"additional","affiliation":[{"name":"Department of Pathology and Cytology, University Hospital Centre Zagreb","place":["Zagreb, Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana","family":"Ili\u0107","sequence":"additional","affiliation":[{"name":"Department of Pathology and Cytology, University Hospital Centre Zagreb","place":["Zagreb, Croatia"]},{"name":"Department of Pathology and Cytology, University Hospital Dubrava","place":["Zagreb, Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ida","family":"Ivek","sequence":"additional","affiliation":[{"name":"Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb","place":["Zagreb, Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Divjak","sequence":"additional","affiliation":[{"name":"Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb","place":["Zagreb, 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Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radovan","family":"Vrhovac","sequence":"additional","affiliation":[{"name":"Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb","place":["Zagreb, Croatia"]},{"name":"Department of Internal Medicine, University of Zagreb School of Medicine","place":["Zagreb, Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vilma","family":"Dembitz","sequence":"additional","affiliation":[{"name":"Department of Physiology and Croatian Institute for Brain Research, University of Zagreb School of Medicine","place":["Zagreb, Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drago","family":"Batini\u0107","sequence":"additional","affiliation":[{"name":"Department of Laboratory Immunology, Clinical Department of Laboratory Diagnostics, University Hospital Centre Zagreb","place":["Zagreb, Croatia"]},{"name":"Department of Physiology and Croatian 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