09 April 2009
Am J Case Rep 2009; 10:39-43 :: ID: 869622
Background: The mechanisms of chronic myeloid leukemia (CML) transformation into a blast crisis (BC) are not fully understood.
Case Report: We report a case of an acute myeloid leukemia with normal karyotype successfully treated with autologous stem cell transplantation (SCT). Two years later the patient developed CML (p210BCR-ABL positive) that was treated with imatinib. BCs of changing immunophenotype (biphenotypic, biclonal, myeolomonoblastic, monoblastic, myeloblastic) were diagnosed in the next four years. CML was treated with allogeneic SCT from an unrelated donor. In the post-transplant period a disappearance of p210BCR-ABL and conversion to p190BCR-ABL was documented. Moreover, a molecular study of p210 transcript revealed the presence of F311L mutation. Sequencing of p190BCR-ABL has shown a presence of both mutant (F311L) and native BCR-ABL. Three months after the transplantation hematological remission was lost and symptoms of BC resistant to dasatinib were documented.
Conclusions: We hypothesize that p190 has been derived from the existing p210 Philadelphia chromosome. It would be possible if a deletion of 36–92 kb fragment from the Philadelphia chromosome (BCR exons 2-14 and a part of intron 1) occurred, however the alternative splicing seems to be more probable explanation. It cannot be also excluded that p210BCR-ABL and p190BCR-ABL originated from different subclones of leukemic cells. This may confirm the oligoclonality of CML in presented case.
Keywords: blast crises, chronic myeloid leukemia, phenotypic and genotypic variability, Stem Cell Transplantation, tyrosine kinase inhibitors
19 May 2022 : Case reportBilateral Emphysematous Pyelonephritis Associated with COVID Pneumonia: A Case Report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936370
17 May 2022 : Case reportHigh-Frequency Oscillatory Ventilation for Refractory Hypoxemia in Severe COVID-19 Pneumonia: A Small Case ...
Am J Case Rep In Press; DOI: 10.12659/AJCR.936651
13 May 2022 : Case reportA case of exacerbation of haloperidol-induced rhabdomyolysis following the onset of COVID-19
Am J Case Rep In Press; DOI: 10.12659/AJCR.936589
23 May 2022 : Case reportPharmacological and Behavioral Strategies to Improve Vision in Acquired Pendular Nystagmus
Am J Case Rep In Press; DOI: 10.12659/AJCR.935148
23 May 2022 : Case reportA Case of Methicillin-Sensitive Staphylococcus aureus (MSSA) Prostate Abscess, Osteomyelitis, and Myositis ...
Am J Case Rep In Press; DOI: 10.12659/AJCR.936704
23 May 2022 : Case reportAdalimumab Mitigates Lumbar Radiculopathy in a Case of Ankylosing Spondylitis
Am J Case Rep In Press; DOI: 10.12659/AJCR.936600
Most Viewed Current Articles
23 Feb 2022 : Case reportPenile Necrosis Associated with Local Intravenous Injection of Cocaine
Am J Case Rep 2022; 23:e935250
17 Feb 2022 : Case reportMyocarditis, Pulmonary Hemorrhage, and Extensive Myositis with Rhabdomyolysis 12 Days After First Dose of P...
Am J Case Rep 2022; 23:e934399
06 Dec 2021 : Case reportLipedema Can Be Treated Non-Surgically: A Report of 5 Cases
Am J Case Rep 2021; 22:e934406