Successful treatment of lymphoid blastic crisis in chronic myelogenous leukemia with the additional bcr/abl transcript using imatinib-combined chemotherapy and high-dose chemotherapy with allogeneic bone marrow stem cell transplantation
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Chronic myelogenous leukemia (CML) is a myeloproliferative disorder characterized by the presence of the Philadelphia chromosome. Although the major BCR/ABL transcript is present in majority of CML patients, the minor BCR/ABL transcript is rarely reported as an additional chromosomal abnormality related to the progression of CML. We describe the case of a 37-year-old woman who had CML and pain in the extremities. She was diagnosed with lymphoid blast crisis of CML on the basis of the following findings: presence of promyelocytes, myelocytes, and metamyelocytes in peripheral blood smear; detection of major and minor BCR/ABL transcripts by polymerase chain reaction analysis; proliferation of lymphoblastic cells with abnormal B-cell phenotype; and aberrant expression of myeloid antigens in the bone marrow. The patient underwent one course of idarubicin and cytosine arabinose therapy combined with imatinib followed by daunorubicin/cyclophosphamide plus vincristine and prednisone/l-asparaginase (DNR/COP/l-ASP) therapy, high-dose cytosine arabinose, and CHOP therapy (cyclophosphamide, doxorubicin, vincristine, and prednisolone). Subsequently, the patient underwent high-dose chemotherapy (total body irradiation and cyclophosphamide) followed by allogeneic bone marrow stem cell transplantation from a human leukocyte antigen (HLA)-matched unrelated donor. After these treatments, the patient was disease-free for 19 months. Our case suggests that these treatments may be feasible, safe, and effective for the treatment of patients with blast crisis CML expressing the minor BCR/ABL transcript.
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- Successful treatment of lymphoid blastic crisis in chronic myelogenous leukemia with the additional bcr/abl transcript using imatinib-combined chemotherapy and high-dose chemotherapy with allogeneic bone marrow stem cell transplantation
International Journal of Hematology
Volume 94, Issue 6 , pp 561-566
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links
- Chronic myelogenous leukemia
- Lymphoid blastic crisis
- Additional bcr/abl transcript
- Allogeneic bone marrow stem cell transplantation
- Industry Sectors
- Author Affiliations
- 1. Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
- 2. Department of Internal Medicine, Hematology, Faculty of Medicine, Saitama Medical Center Jichi Medical University, Saitama, Japan
- 3. Department of Clinical Laboratory, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
- 4. Department of Oral and Maxillofacial Surgery, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
- 5. Department of Dermatology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan