13 September 2020
: Case report 
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. Zaidi1ABCDEFDOI: 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 treatment | White blood cells (×109/L) | Hemoglobin (g/dL) | Platelets (×109/L) | Bone marrow blasts (%) | Karyotype/FISH for BCR: ABL | RTQ-PCR for BCR: ABL p210 | Overall systematicand CNS remission status |
|---|---|---|---|---|---|---|---|
| At diagnosis | 26×10/L with (Eosinophils: 1% Basophils: 0% Blasts: 10%) | 7 g/dL | 194×10/L | 11% blasts with increased eosinophilic & basophilic precursors | 47,XX, +7, t(9,22) (q34,q11.2) FISH showing BCR-ABL fusion signals in 5% scored nuclei | 86.7% | CML – Accelerated Phase |
| At 24 months (on Imatinib) | 2.36×10/L No immature cells | 9.48 g/dL | 85.4×10/L | 1% blasts with normal myeloid immuno-phenotype | 46, 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 cells | 9.82 g/dL | 145×10/L | <1% blasts with hypocellular bone marrow with a cellularity of 30% | 46, 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 cells | 10.1 g/dL | 151×10/L | 1% 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 α | 1.42×10/L No immature cells | 8.9 g/dL | 115×10/L | Patient refused bone marrow biopsy | 46, XX[] FISH negative for BCR-ABL fusion signal20 | 0.0012% (IS) | In deep molecular remission, and CNS clear |
| On end of PEG-Interferon α | 1.12×10/L No immature cells | 9.1 g/dL | 195×10/L | Patient refused bone marrow biopsy | 46, XX[] FISH negative for BCR-ABL fusion signal20 | Not detected | In deep molecular remission, No CNS manifestations |
| During treatment free remission | 5.53×10/L No immature cells | 9.3 g/dL | 330×10/L | 46, XX[] FISH negative for BCR-ABL fusion signal20 | Not detected | In deep molecular remission, No CNS manifestations |