Conference Abstracts - 2025 Summit on Hematologic Cancers
Vol. 5, Issue Supplement 1, 2025 · S1-2
Itching for a diagnosis: Early T-cell Precursor Acute Lymphoblastic Leukemia presenting as a rash with pancytopenia
Clark Cutrer, MD,Ronald Hamrick, MD,Sidharth Mahajan, MD,Sarah Depew, MD
Submission received: 2025-07-10 / Accepted: 2025-07-28 / Published: 2025-09-17
Introduction
Early T-cell precursor acute lymphoblastic leukemia (ETP-ALL) is a rare subtype of T-cell acute lymphoblastic leukemia (T-ALL), accounting for 7-12% of childhood and adult T-cell ALL cases (1). Cutaneous involvement is a very rare phenomenon in this disease and is only sparsely described in the literature (2).
Case presentation
Our patient is a 55-year-old male with a history of Wolff-Parkinson-White syndrome who had a diffuse erythematous and pruritic rash ongoing for several months. Multiple biopsies demonstrated eczematous rash, and he was treated with topical therapy with little improvement. Developed neutropenia and ultimately had a bone marrow biopsy, which demonstrated over 90% involvement by T-cell acute lymphoblastic leukemia, further characterized as ETP-ALL based on immunohistochemistry.
He was admitted for induction, and prior to starting treatment, he had a repeat skin biopsy, which demonstrated cutaneous involvement by ETP-ALL. The patient was started on treatment with an augmented hyperCVAD protocol with the addition of pegaspargase. Within the first cycle, the rash completely resolved, and he achieved complete remission. Of note, he also had evidence of central nervous system (CNS) involvement, but this also cleared with continued treatment and intermittent lumbar punctures with intrathecal methotrexate and cytarabine. He ultimately completed 8 total cycles of therapy and had a matched-unrelated donor allogeneic hematopoietic stem cell transplant (HSCT).
Conclusion
ETP-ALL is a rare and very high-risk variant of T-cell ALL with a 5-year survival of 35% in adults and increased risk of recurrence compared with non-early T-cell ALL (1). Presentation can vary in this disease, and though rare, skin manifestations and other extramedullary sites are well-described in the literature (3). This case highlights the need for prompt diagnosis and treatment in this aggressive disease.