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The role of imatinib in childhood Philadelphia chromosome-positive (Ph(+)) acute lymphoblastic leukemia (ALL) has not been established. We treated four children with imatinib in combination with conventional chemotherapy (CT) before stem cell transplantation (SCT). Response evaluation consisted of fluorocytometric analysis of minimal residual disease (MRD) and standard qualitative RT-PCR follow-up.

Erythrophagocytosis by neoplastic cells in acute leukemia has been most frequently associated with FAB M4 and M5 subtypes, with the t(8;16) and with C-MOZ rearrangements, however it is exceptional in acute lymphoblastic leukemia and has not been previously reported in Philadelphia-positive (Ph+) acute leukemia. We herein present a case of Ph+ acute leukemia of ambiguous lineage in which erythrophagocytosis is an outstanding feature. The implications between the different postulated leukemogenic pathways and the hypothesized mechanism of erythrophagocytosis are concisely reviewed and discussed.