A rare case of B-lymphoid blast phase of chronic myeloid leukemia: Diagnostic challenges

Nada Naiyer; Ann-Leslie Zaslav; Tahmeena Ahmed; Silvia Spitzer; Yupo Ma; Roxanna Ponce; Htien Lee; Hong Lin

doi:10.1016/j.lrr.2022.100327

A rare case of B-lymphoid blast phase of chronic myeloid leukemia: Diagnostic challenges

Leuk Res Rep. 2022 May 20:17:100327. doi: 10.1016/j.lrr.2022.100327. eCollection 2022.

Authors

Nada Naiyer¹, Ann-Leslie Zaslav¹, Tahmeena Ahmed¹, Silvia Spitzer¹, Yupo Ma¹, Roxanna Ponce¹, Htien Lee¹, Hong Lin¹

Affiliation

¹ Department of Pathology, Stony Brook University School of Medicine, 101 Nicolls Road, Stony Brook, New York 11794-7300, United States.

Abstract

Chronic myeloid leukemia(CML) is characterized by Philadelphia(Ph) chromosome. About 5% of cases are diagnosed in blast phase. We report a case of a 53-year-old female with no significant medical history, in B-lymphoblast crisis. Flow cytometry demonstrated B-lymphoblasts with no myeloid aberrancies, together with immature neutrophils in blood, and B-lymphoblasts in bone marrow. Cytogenetic studies identified Ph+ with complex abnormalities. Molecular analysis showed positive both for p210 and p190 transcripts in blood. ABL1 mutation analysis by Next Generation Sequencing(NGS) detected Thr315Ile mutation, which confers resistance to many tyrosine kinase inhibitors(TKIs). Eight months later she received allogeneic transplant and is doing well.

Keywords: Acute lymphoblastic leukemia; BCR-ABL1; CML blast phase; Chronic myeloid leukemia; Cytogenetics; Flow cytometry.

Publication types

Case Reports