engleski

Myeloid/Megakaryocytic Blast Phases as a Presenting Manifestation of Chronic Myeloid Leukemia: Case Report

Chronic myeloid leukemia is a myeloproliferative disease that originate in an abnormal pluripotent bone marrow stem cell and is consistently associated with the Philadelphia chromosome and/or BCR/ABL fusion gene. The disease is bi- or triphasic: an initial indolent chronic phase is followed by one or both of the agressive transformed phase, accelerated and blast phase (crisis). The majority of patients are diagnosed in the chronic phase. The blast phase resembles acute leukemia. Blast crisis as a presentig manifestation of CML is rare. Here we report a 23-year-old man with no prior hematologic disease, who presented with fever, gluteal pain, hepatosplenomegaly, unspecific skeletal lesions. White blood count was 121, 6 x 109. Bone marrow aspiration of breastbone revealed the chronic phase of CML. Bone marrow aspiration of the pelvic bone (crista posterior) after 6 days revealed the accelerated phase of CML with 10 % atypical blasts. Bone marrow aspiration (crista posterior) after 8 days indicated blastic transformation of CML with 61% poorly differentiated blasts. Blasts expressed ANAE 75%, partly CD61 33% and MPO 21%. Using RT-PCR we detected BCR/ABL fusion gene and the abnormal fusion transcript, p210.The karyotyype was: 46, xy, t(9 ; 22) [6]/36, idem, -3, -4, del(5q), -7, del(8p), -13, -15, -16, -17, -20, -22(cp19). Here we reported the blast crisis as a presenting manifestation of CML with megakaryocytic and myeloid differentation.

Chronic myeloid leukemia; blast phase with megakaryocytic and myeloid differentation

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