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13 September 2020 : Case report  Saudi Arabia

Prolonged Survival of a Patient with Chronic Myeloid Leukemia in Accelerated Phase with Recurrent Isolated Central Nervous System Blast Crisis

Unusual clinical course, Unusual or unexpected effect of treatment

Ahmed A. Bin Salman1ABCDEF*, Abdul Rehman Zia Zaidi12ABCDEF, Syed Yasir Altaf1E, Nawal F. AlShehry1E, Imran K. Tailor1E, Ibraheem H. Motabi1E, Syed Ziauddin A. Zaidi1ABCDEF

DOI: 10.12659/AJCR.922971

Am J Case Rep 2020; 21:e922971

Table 1. Hematological and molecular response of patient during the course of treatment.

Course of treatmentWhite blood cells (×109/L)Hemoglobin (g/dL)Platelets (×109/L)Bone marrow blasts (%)Karyotype/FISH for BCR: ABLRTQ-PCR for BCR: ABL p210Overall systematicand CNS remission status
At diagnosis26×10/L with (Eosinophils: 1% Basophils: 0% Blasts: 10%)7 g/dL194×10/L11% blasts with increased eosinophilic & basophilic precursors47,XX, +7, t(9,22) (q34,q11.2) FISH showing BCR-ABL fusion signals in 5% scored nuclei86.7%CML – Accelerated Phase
At 24 months (on Imatinib)2.36×10/L No immature cells9.48 g/dL85.4×10/L1% blasts with normal myeloid immuno-phenotype46, XX[] FISH negative for BCR-ABL fusion signal20 0.001048 (IS)CML in deep molecular remission
At 1 CNS Blast Crisis (on TITs and Dasatinib)4.84×10/L No immature cells9.82 g/dL145×10/L46, XX[] FISH negative for BCR-ABL fusion signal20 0.000131 (IS)Isolated CNS Blast Crisis (CSF had 31% blasts by morphology and 43% of myeloblasts by flow cytometry) with deep molecular remission in bone marrow
At 2 CNS Blast Crisis (On WBR and Dasatinib)1.32×10/L No immature cells10.1 g/dL151×10/L1% blasts with marrow cellularity of 50%46, XX[] FISH negative for BCR-ABL fusion signal20 0.00019% (IS)Isolated CNS Blast Crisis (CSF had 50% blasts by morphology and 52% of myeloblasts co-expressing CD7 by flowcytometry) with deep molecular remission in bone marrow
On start of PEG-Interferon α1.42×10/L No immature cells8.9 g/dL115×10/LPatient refused bone marrow biopsy46, XX[] FISH negative for BCR-ABL fusion signal20 0.0012% (IS)In deep molecular remission, and CNS clear
On end of PEG-Interferon α1.12×10/L No immature cells9.1 g/dL195×10/LPatient refused bone marrow biopsy46, XX[] FISH negative for BCR-ABL fusion signal20 Not detectedIn deep molecular remission, No CNS manifestations
During treatment free remission5.53×10/L No immature cells9.3 g/dL330×10/L46, XX[] FISH negative for BCR-ABL fusion signal20 Not detectedIn deep molecular remission, No CNS manifestations

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923