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lüll Transformation of the 5q- syndrome to acute lymphoblastic leukemia: a report of two cases and review of the literature Agostino NM; Ahmed B; Popescu D; Gheith SInt J Clin Exp Pathol 2011[Mar]; 4 (3): 322-6Myelodysplastic syndrome (MDS) with an isolated deletion of the long arm of chromosome 5 (5q- syndrome) is a distinct subtype of MDS with an indolent course that rarely transforms to acute leukemia. Deletion of the long arm of chromosome 5 has also been reported in rare cases of de novo B-lymphoblastic leukemia. We present two cases of 5q- syndrome with a similar and unusual course of transformation to lymphoblastic leukemia while on Lenalidomide. These two patients achieved an initial response; however, later acquired a second cytogenetic abnormality, became refractory to treatment and evolved into acute leukemia. At the time of transformation, both patients had recurrence of the 5q- abnormality. Review of the literature and the mechanisms of transformation of the 5q-syndrome into an acute leukemia are discussed. Although the relationship between the events in our cases remains unclear, the intriguing similarity between the two cases raises a question whether immune modulators can alter the natural course of MDS. To our knowledge, no similar cases were previously reported in the literature.|Aged[MESH]|Aged, 80 and over[MESH]|Anemia, Macrocytic/genetics[MESH]|Chromosome Aberrations[MESH]|Chromosome Deletion[MESH]|Chromosomes, Human, Pair 5/genetics[MESH]|Female[MESH]|Humans[MESH]|Male[MESH]|Precursor Cell Lymphoblastic Leukemia-Lymphoma/*genetics[MESH] |