International Journal of Hematology

, Volume 94, Issue 6, pp 561–566

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

  • Noriaki Kawano
  • Shinya Okuda
  • Shuro Yoshida
  • Hiroko Kugimiya
  • Masaki Ito
  • Nagako Horikawa
  • Nobuaki Chosa
  • Tomoko Hisakata
  • Tomoko Fukudome
  • Ryoko Sakurai
  • Kiyoshi Yamashita
  • Akira Ueda
  • Yoshinobu Kanda
Case Report

Abstract

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.

Keywords

Chronic myelogenous leukemia Lymphoid blastic crisis Additional bcr/abl transcript Imatinib Allogeneic bone marrow stem cell transplantation 

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Copyright information

© The Japanese Society of Hematology 2011

Authors and Affiliations

  • Noriaki Kawano
    • 1
  • Shinya Okuda
    • 2
  • Shuro Yoshida
    • 1
  • Hiroko Kugimiya
    • 3
  • Masaki Ito
    • 4
  • Nagako Horikawa
    • 5
  • Nobuaki Chosa
    • 5
  • Tomoko Hisakata
    • 3
  • Tomoko Fukudome
    • 3
  • Ryoko Sakurai
    • 3
  • Kiyoshi Yamashita
    • 1
  • Akira Ueda
    • 1
  • Yoshinobu Kanda
    • 2
  1. 1.Department of Internal MedicineMiyazaki Prefectural Miyazaki HospitalMiyazakiJapan
  2. 2.Department of Internal Medicine, Hematology, Faculty of MedicineSaitama Medical Center Jichi Medical UniversitySaitamaJapan
  3. 3.Department of Clinical LaboratoryMiyazaki Prefectural Miyazaki HospitalMiyazakiJapan
  4. 4.Department of Oral and Maxillofacial SurgeryMiyazaki Prefectural Miyazaki HospitalMiyazakiJapan
  5. 5.Department of DermatologyMiyazaki Prefectural Miyazaki HospitalMiyazakiJapan

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