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Acute lymphoblastic leukemia (ALL) is a malignant disease of lymphoid precursors. According to immunophenotype, it is further subdivided into precursor B cell ALL and precursor T cell ALL, with precursor B cell ALL being much more common both in children and adults. Lineage switch from one lymphoid lineage to another during the course of the disease is extremely rarely reported. Here, we describe a case of a child who initially presented as a precursor BALL but 15 years later and after two successfully treated relapses of the original ALL presented with early T cell precursor leukemia. Although it was considered as a relapse, it could be interpreted as a case of secondary leukemia, which can be explained as a consequence of treatment as well as a constitutional feature of an individual. Also, it draws attention to the possibility that hematopoietic cells, and in that context also leukemic cells, are much more plastic and capable of reprogramming than previously thought.

Biologic treatments including antibody-based therapies are still in early-phase development in Hodgkin lymphoma. The authors present the case of a 10-year-old girl with massive, solid, unilateral cervical, nodular lymphocyte-predominant Hodgkin lymphoma. Chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine [ABVD]) and radiotherapy were given, according to the Italian Association of Pediatric Hematology and Oncology (AIEOP) MH-96 study protocol, but the patient failed to enter complete remission. Soon after, 6 intravenous infusions of the chimeric anti-CD20 monoclonal antibody rituximab 375 mg/m2 were administered, resulting in complete remission. The patients is still in continuous complete remission for 2 years. Novel therapies, such as rituximab, may be useful for children with CD20+ nodular lymphocyte-predominant Hodgkin lymphoma. To the authors' knowledge, this is the first report of CD20+ nodular lymphocyte-predominant Hodgkin lymphoma treated with rituximab in children. Further controlled trials and long-term outcome studies are warranted to define its clinical application and to improve the care of patients.