#Ara-C
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An ‘Uncommon early lineage switch’ in an MLL rearranged adult B-lineage Acute Lymphoblastic Leukemia to Mixed-phenotypic acute leukemia (B/Myeloid) by Narendra Agrawal in International Journal of Clinical Images and Medical Reviews
Case Report
Lineage switch is an infrequent phenomenon with an incidence of ~ 0.6% of all de novo leukemias and seen in almost 6% of relapsed cases. This phenomenon is observed following therapy or at the time of relapse. Switch in lineage tends to occur in younger patients and is associated with particularly poor outcomes.[1]
https://ijcimr.org/wp-content/uploads/2022/01/Fig-1__1_.jpg
Discussion
Our clinical report illustrates an adult refractory B -ALL with t (4;11) (q21;23), AF4:MLL fusion who transformed to Mixed-phenotypic acute leukemia;KMT2A-rearranged during his second month of therapy. Lineage switch in MLL rearranged paediatric ALL is common, but in adults it is not well reported. During the literature review, we found 2 cases of adult ALL harbouring t (4;11) transformed to AML [1,4]. First case illustrated chemotherapy responsive MLL rearranged B-ALL who underwent allogeneic stem cell transplantation (Allo SCT) in remission after induction therapy, who transformed to AML post 100 days of Allo SCT[4]. Second case illustrated refractory MLL rearranged B-ALL adult that rapidly transformed to AML following initiation of blinatumomab therapy [1]. However there was no case found to have switched from B acute lymphoblastic leukemia to Mixed-phenotypic acute leukemia;KMT2A-rearranged .Mechanism for lineage switch in MLL rearranged acute leukemia is not clear yet. Reports showing a strong trend of lineage switch involving B and myeloid lineages suggest that B myeloid progenitor might be involved in the mechanism of lineage switch. Studies reporting lineage switch post anti CD19 therapy; blinatumomab and CD19 chimeric antigen receptor (CAR-T), further advocates this theory [3].In our case it is not possible to state that transformation occurred post Venetoclax therapy, as flow cytometric evaluation was not done prior to start of venetoclax therapy. Development of secondary AML as a result of therapy related process can be ruled out in view of early lineage switch (< 6 months of therapy) and consistent finding of the t (4;11) (q21;23) at diagnosis of B-ALL and transformation. The (4;11) rearrangement detected at diagnosis, and phenotypic switch suggests that the original clone harboured a bi-lineage potential. If further genetic studies including NGS or gene expression studies done at baseline could have predicted the bi lineage potential is also unclear as the case reported by Haddox C et al did not show any change in the baseline NGS and the NGS performed during relapse.In conclusion, haematologists should be cognizant while treating MLL rearranged B -ALL adults for a lineage switch. It also underlies the importance of repeat evaluation of the disease if there is no response to standard therapy.
Declarations
Funding Funding information is not applicable to this study.Conflict of Interest All authors declare no conflict of interest to declare.Compliance with Ethical Standards Ethical Approval Statement: All authors stated that the study has been approved by the appropriate institutional review board and have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.Acknowledgement We are thankful to our RGCI & RC staff of department of Hematology for their constant supportFor more details: https://ijcimr.org/editorial-board/
#Lineage switch#phenomenon#ALL#Mixed leukemia lineage#acute lymphoblastic leukemia#AML#MLL#acute myeloid leukemia#CD#chemotherapy#dysfunction syndrome#Ara-C#Narendra Agrawal
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bunch of signalis doodles
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Hc that grian used to play the hit game D4DJ back in the yhs series to cope with the things that were happening and still plays it to this day on hermitcraft 😋😋
#kuuyoooo..orwtv#yhs#yhs grian#grian yhs#yandere high school#hermitcraft#grian#c!grian#d4dj#d4dj groovy mix#is this some weird projection? maybe who knows#but what we do know is that grian's favourite character is maho!! and his favourite group is happy ara!! :3#is this another projection? maybe :3
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i genuinely love characters never forgiving each other so much! Especially if the other is redeemed or sympathetic or even a good person who fucked up. Like yes sweetie stay a petty bitter bitch, sometimes healing includes a dash of Resent and Remember
#empty thoughts#post s8 au#c&ai au#Ngl this is about my aus#Ps8!Kuron never forgives ps8!Allura Shiro and Keith#And ps8!Allura never forgives Lotor Honerva and Zarkon#C&ai!team never forgives Lance or Keith even if they do care miss and love them#And C&ai!Lance never forgives the team even if he misses and loves and cares about them#Ara never forgives Keith and has given up on him even if they understand#Kid never forgives Keith and there is no love there
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Photo
#çağatay ulusoy#cagatay ulusoy#İçerde#icerde#aras bulut İynemli#aras bulut iynemli#just being the cutest things to have ever lived i guess#turkish fc#turkishfc#c: berat yalaz#brotp#brotp inspo#not to be dramatic but#might be the love of my life
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@boomermania sent: ♡ Basil for Arabella Hahahha
Send ♡ to see what my muse thinks of yours
○○○○○ | ATTRACTION ○○○○○ | AFFECTION ○○○○○ | INTEREST ○○○○○ | LOYALTY ○○○○○ | TRUST
You get nothing, Basil.
#&& asks / seeking what is true is not seeking what is desirable#boomermania#&& c. arabella / bloodied blossoms#thank you for the ask!#he has blown it with ara at this point kfbkgbf
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━━ next gen season 002◞ who's the anti-hero?.· ( @arabe )
if there was one contestant jiayi had been looking forward to meeting, it was ara. though they've greeted each other in the halls and given each other passing glances, that wasn't enough time to get to know each other properly. jiayi finds herself beyond excited when their names are called together, finally having the chance to work together.
everyone knows that the best conversations happen during downtime. while they take five minutes to rest, jiayi decides to strike up a casual conversation, trying to get to know the other better.
"you know, i did rhythmic gymnastics growing up," she tells the other, casually moving the scarf around in her hand, following the choreography but at a slower pace. "this isn't the same, obviously," jiayi laughs, looking over at ara. "but it reminded me of the ribbons we used to use for performances and stuff. i'm glad we get to use such pretty props for the finale."
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Should I wear a short without tights, like, just stocks going below my knees...
#i haven't shown a peace of skin from my leg since primary school help#it's gonna be over 22°C soo idk...#my top has Victorian vibe apparently... like I have a corset and short sleeves but... I don't know what it's called but a little pulled up#bref.#idk#my knees and the ara just above are exposed lesifjdhz should I ???#mes blogs
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☭ || & @wonwars liked for a starter (natasha) !!
__________✧ A SMIRK CROSSES HER LIPS AS SHE WIPES A BEAD OF SWEAT FROM HER TEMPLE. it’s not often a sparring partner even causes her breathing to quicken, let alone demand sweat && hard earned effort ( but steve is a worthy opponent, another super soldier trained to be the best ) they are far more similar than most would believe. ❛ don’t take it too seriously, rogers. you took that last hit like a champ. maybe you’ll win our next match. ❜
#c; natasha romanoff#wonwars#(( ARA MY LOVE I HAVE MISSED YOU ))#(( also she's an asshole and i love her ))
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"i agree with you. it's also different than what i had expected. though, i guess i'm not sure what i was supposed to have expected after next gen, " jiayi says, confiding in ara. she's sure there are other people here who were trainees at different companies like she was, but she doesn't know if they've all experienced the same as she has. "i didn't really understand why we were thrown into a workshop so suddenly, i thought there would be sort of . . . " the dancer trails off, biting her lip while looking for the right words. "an adjustment period."
"i'm getting the hand of it though," she tells the other with a smile. "after all, it's kind of sink or swim, you know?" jiayi laughs. "you have to come out of it on top or else," she jokes around with the other, waiting for her to give her take.
"its been...." honest? slight under-exaggeration? don't express the woes? "different from what i expected in some ways, but also what i expected when i thought about what it is to be a trainee. but i guess that might be different under every company, yea." what ara means is, she doesn't know how much she actually is on route with the acting bits, but hey, everyone has to start somewhere.
"how about you? getting the hang of everything?" she's happy that she gets to see her here, and perhaps they could always 'keep up' with each other that way, especially since they'd worked together well, along with friendly competition that kept them on their toes. being a trainee from square one had put a lot into perspective for ara. and it was good to see how far others were, especially the trainees that had been here for a longer time to see where their progress was. of where she could hopefully approach one day.
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TAC
sauropoda is a clade of saurischia that includes some of the largest dinosaurs we currently know of. if i'm going to submit something to you it's going to include these guys. they include some familiar faces like the brontosaurus. but the largest specimen within this group is a giant barosaurus fossil.
credit to Paleonerd01 on DeviantArt
they've inhbabited every continent (including Antarctica!) and give us those comically large prints we're so fond of zooming out on.
another good giant friend of mine is the colossal squid. why do they keep making bigger squids? because i love them. i love their huge eyes and big fights with sperm whales. i love their elusiveness. i love that we went "kraken?" haha very funny. cthulhu? sure guys. and they EXIST <333
credit to Te Ara in New Zealand
and charismatic megafauna are cool and all but have you considered something a little smaller? maybe a Black Capped Chickadee? they tend to travel in groups or two or more when they're flying outside the nest and their call "chicka dee" functions as a warning call of increasing intensity depending on how many "dee"s they add.
and bugs? here's the thing: i have fought with Polistes metricus for years growing up. have they stung all of my loved ones? absolutely. do they also eat an invasive species of worm in my area? yes. and while these guys will sting you without a second thought and fly away laughing, they are a necessary evil. just like the birds, they stop for a sip of water. they are, i must admit through gritted teeth, an important part of my ecosystem.
ATT
String identified: TAC
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t' at ctt (cg Atactca!) a g t cca ag t ' g t .
at g gat t ca . t ag gg ? ca t. t g a g gt t a. t . tat t "a?" aa . ct? g. a t T <333 ct t T Aa aa
a caatc gaaa a c a a t a c tg a tt a? a a ac Ca Cca? t t t ta g t t' g t t t a t ca "cca " ct a a ag ca cag tt g a "" t a.
a g? ' t tg: a gt t t tc a gg . a t tg a ? at. t a at a a c aa? . a t g tg tt a c tgt a aa agg, t a a ca . t t , t t a at. t a, t at tg gtt tt, a tat at ct.
ATT
Closest match: Acipenser ruthenus genome assembly, chromosome: 41 Common name: Sterlet sturgeon
#tumblr genetics#genetics#asks#requests#sent to me#all-0f-the-above#fish#ocean#sturgeons#sterlet sturgeon#giant squid#squids#yet another organism that does not look real
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How would each ro act after the first morning after waking up next to mc?
FINALLY tackling the old asks! Sorry for taking a while everyone :^3
✦ How do the LIs act after waking up next to the MC for the first time
✦ Amon: Gives the MC a casual "Mornin'" while stretching. He's not a morning person at all so he hugs the MC from behind and buries his face on the crook of their neck, breathing them in. He falls asleep soon after and doesn't let the MC leave the bed.
✦ Raeya: She wakes up before the MC, a bit disorientated. She has to take her time just trying to make sense of her emotions as she watches the MC breathe. She doesn't wake the MC up and goes on about her duties, leaving a letter behind for the MC.
✦ Gael: He's fast asleep, a rare occurrence. He looks so peaceful with the timid morning sun caressing his face. Then his lashes flutter open and he looks at the MC with a smile, lifting a hand to lovingly brush their cheek. "You look heavenly," he mumbles.
✦ Envy: The MC has to wake them up because damn he's sound asleep and he's holding the MC too tight—! They're, of course, terribly flustered and grumpy about being woken up and having been caught in such a position. "C-can't you see I'm trying to sleep? Go away if you are bored."
✦ Ara: She wakes the MC up with kisses, tickles and a bit of wrestling! She's so so happy to have spent the night with the MC and she wants them to know. She wants nothing but to just lay around for a bit and talk, enjoying a lazy morning!
✦ Xal: He's mortified. He doesn't know what he's supposed to do now—he never expected to get this far to begin with. He has to act cool but doesn't know what to say or do, wants to touch the MC but is afraid of waking them up...So he just lays there, still and barely breathing, watching them sleep.
✦ Father Pride: Gently wakes the MC up with kisses. It all comes natural to him. "It is morning, my dear," he whispers in their ear. "There are things I must attend to."
✦ Lázaro: They're already up and about, preparing breakfast. Their hair is a mess, their pajamas are a mess...They're not used to waking up this early, but they want to do something romantic for their first morning with the MC.
✦ Cécile: Most likely didn't sleep. He instead spent the whole night watching the MC closely, careful of every breath they take, feeling them alive next to him. Probably has touched the MC's lips or hands to see them react in their sleep. When the MC wakes up, he's already up, dressed, and completely fresh.
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Chat how do i make an absolutely horrendous ass hairstyle from feathers? It's for an oc
#c&ai au#I just want to keep the tradition of Keith's family having terrible haircuts#I am finally designing Kid and Ara#And yes I am looking up raptor fursonas for ideas#But also Shitty hairstyles for Kid#I don't want to give her bowlcut even I am not that cruel#Fringed buzz cut (with ponytail) and frosted tips have potential though#Also whatever the fuck Nami's mom was doing. Ngl she pulled it off well
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C: Benim Mogrul, dört göz fani.. Bu mektubu sana çok uzak bir diyardan ve çok uzak bir zamandan yazıyorum. Gittiğinden beri çok uzun zaman geçti ve birçok şey değişti. Hanımın yavaş yavaş büyüyor ve bu güçlerini etkiliyor. Bir yandan iyi bir yandan kötü ama her şeye rağmen baş etmeye çalışıyorum. Küçükken yeterince huysuz değilmiş gibi.. Büyüdükçe çok daha fazla huysuz hale geldi ama yapacak bir şey yok. Bazen sinirleniyorum bazen de sakin kalmaya çalışıyorum. Tıpkı bana benziyor.. İstemediği bir şey olunca hemen beni tehdit ediyor ve üstünlük kurmayı deniyor. Bazen yemiş numarası yapıp haklı çıkmasını sağlıyorum ve içten içe olan mutluluğunu fark edebiliyorum. Anlayacağın bizim için her şey çok iyi gidiyor. Mektubuma güzel şeyleri anlatarak devam etmek isterdim ama özür dileyerek söylüyorum ki sana çok kızgın. Mektubu onun yazması için birçok şey yaptım ama başaramadım. Onu terk ettiğini ve arkasından bıçakladığını düşünüyor. Birçok kez konuştum ama onu çok iyi tanıyorsun ve konuşmak istemediğinde nasıl birine dönüştüğünü en iyi sen biliyorsun. Sen gittikten sonra ara ara denemeye devam ettim ama sonuçlar hep aynı. Ama hiç merak etme denemeye devam edeceğim. Aslında sana kızgın olması kötü olan ikinci konu olabilir. Yanında onu koruyan yeni bir şey var ve sanırım senin gibi değil Mogrul. Saf bir kötü o. Adı Aazighal ve sanırım hanımının yeni koruyucusu. Bunu duymak canını yakabilir ama senin kadar olmasa da iyi anlaşıyorlar ve o saçma kitabı da okuyabiliyor. Bu da hanımının çok daha güçlü olması anlamına geliyor. Her neyse, daha fazla canını sıkmak istemiyorum.
Biraz da kendimden bahsedeyim sana. Deminde okuduğun gibi hanımın ile baş etmek bir fani için zor olabiliyor. Her şeye rağmen eğlenceli ve büyük bir tecrübe.. Bu arada gözlüklerimi aldığın için hiç sinirli değilim. Sana benden çok daha fazla yakışıyordu ve bunu kendime yediremediğim için söylemek içimden gelmiyordu ama gerçek bu. Gözlük benim için herhangi bir şey ifade etmeyecektir Mogrul. Ben çirkin bir adamım ve plastikten yapılmış bir şey bunu değiştiremez. Bu arada seninle dalga geçtiğim ve seni kırdığım içinde ayrıca özür dilerim. Hiç hak etmediğini sen gittikten çok sonra anladım. Hanımın çok zor biri ve sen buna rağmen ona yıllarca dayandın. Bir dediğini iki etmedin ve bunu büyük bir özveriyle yaptın. En çok değer vermem gereken kişi sendin ama ben yine yapmamam gereken şeyleri ilk yapmayı seçtim ve her şekilde seninle dalga geçtim. Beni biliyorsun.. Kafam biraz farklı çalışıyor ve bu diğer kişiler için sorun olabiliyor. Umarım beni affedebilecek kadar yüce gönüllüsündür Mogrul. Bu arada tahmin ya da varsayım yapmadığımı bilmeni istiyorum. Evet dostum, cennette olduğunu biliyorum. Bunu iliklerime kadar hissediyorum Mogrul. Cehennemde yaşamayı hak etmiyorsun. Seni hayatını hanımın için yaşadın ve onun için bitirdin. Cehennemden gelen birinin böyle bir şey yapamayacağını herkes bilir. Cennette umarım çok eğleniyor ve hak ettiğin değeri buluyorsundur. Oradaki hurileri nasıl becerdiğini düşünmeden de edemiyorum. Lütfen bunu yaparken gözlüklerimi işin içine karıştırma. Şaka yapıyorum kızma. Bizim tarafımızda durumlar böyle. Umarım sende çok mutlu ve huzurlusundur. Hanımına senin kadar iyi bakamayabilirim ama bir fani için ne kadar iyi bakılabilirse o kadar iyi bakacağımı bilmeni isterim. Senin hanımından bir isteğin vardı ve o isteğini yerine getirdi. Benimle konuştu ve hiç bilmediğim şeyleri bana anlattı. Benimle ilgili olan bütün görüşlerini iyisiyle kötüsüyle dinledim. Hak verdiğim oldu, bazısına da hak vermedim ama bu bir şeyleri değiştirmez. Herkesin kendi görüşleri vardır ve sana saygı duymam gerekirdi. Konu ben bile değilim Mogrul, hanımına bunca sene baktığın için bile senin kulun kölen olmalıydım. Tekrardan özür dilerim. Sen bir gölge değilsin, sen en parlak renge ve en büyük kanatlara sahip bir meleksin Mogrul. Hiçbir zaman kötü biri değildin. Tek yaptığın şey hanımına itaat etmekten başka bir şey değildi. Bunca sene ona hizmet ettiğin için sana binlerce kez teşekkür ederim ama artık senden bir şey isteme sırası bana geldi diye düşünüyorum. Hala beni sevmeye bilirsin ama hanımının hatırı için belki de isteğimi yerine getirirsin..
Anneme onu çok sevdiğimi ve çok özlediğimi söyle olur mu Mogrul? Merak etme bana yaptıklarını gördüyse senin safını tutacaktır. O bu hayatta tanıdığım en adil ve en güçlü kadınlardan birisiydi. Eminim ki sende çok seveceksindir. Ona oğlunun büyüdüğünü söylemeni istiyorum. Onu anmak canımı yaktığı için bunu çok yapmıyorum. Hem çok da dua eden birisi olmadığım için muhtemelen bana kızgındır ama elimden bir şey gelmiyor. Dua etmeyi sevmiyorum. Onun gibi bir anneye sahip olduğum için çok şanslı olduğumu bilmesini sağla Mogrul. Senden ilk ve tek isteğim budur. Ona benim yerime kocaman sarıl, bende burada hanımına sarılacağım.
Mektubumun sonuna geldim Mogrul. Veda etmeyi ya da bir şeyleri bitirmeyi hiçbir zaman beceremediğimi bilirsin. Direkt yazmayı bitirmek istiyorum ama bunu hak etmediğini de biliyorum. Çok garip bir his bu Mogrul. Oturmuş bir meleğe elveda demeye çalışıyorum. Her neyse.. Umarım bu mektup eline geçer ve bizim için ne kadar değerli olduğunu bir kez daha anlayabilirsin.
Unutmadan, mektubun içindeki şeyi ilk kez görmüyorsundur muhtemelen ama o bir güneş gözlüğü ve hanımının. Gözlüğü ondan çaldım ve onu bir yerlerde bırakıp kaybettiğine inandırdım sanırım. Sana hem çok yakışacaktır, hem de hanımından bir şeye sahip olmak hoşuna gidecektir diye düşündüm. Elimden bu kadarı geldi Mogrul, keşke daha büyük bir şekilde sevindirebilseydim seni ama ben bir faniyim.. Benden çok da fazla şey beklememek lazım.
Elveda Mogrul. Bütün karanlıklarının ardındaki o bembeyaz kalbine çok iyi bak.
I: Şimdi bunları mühürle ve ona götür Aazighal. Eğer ona ulaşmazsa ya da onu bulamazsan sende geri gelme.
#Witch#Witches#Wicca#Witchcraft#Witchblr#Pagan#Gothic#Dark#Art#Painting#Artists On Tumblr#Illustration#Aesthetic#Kitap#Alıntı#Edebiyat#Tom Bagshaw
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