Sudden blastic crisis and additional chromosomal abnormalities during chronic myeloid leukemia in the imatinib era

Imatinib has shown significant clinical and cytogenetic success in the treatment of chronic myeloid leukemia. Although resistance has been observed in a proportion of patients, sudden blastic crisis is a rare event during imatinib therapy. We describe a 24-year-old male patient with Philadelphia chr...

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Veröffentlicht in:International journal of clinical oncology 2009-12, Vol.14 (6), p.545-550
Hauptverfasser: Ali, Ridvan, Ozkalemkas, Fahir, Ozkocaman, Vildan, Yakut, Tahsin, Nazlioglu, Hulya Ozturk, Budak, Ferah, Pekgoz, Murat, Korkmaz, Serhat, Karkucak, Mutlu, Ozcelik, Tulay, Tunali, Ahmet
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container_issue 6
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container_title International journal of clinical oncology
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creator Ali, Ridvan
Ozkalemkas, Fahir
Ozkocaman, Vildan
Yakut, Tahsin
Nazlioglu, Hulya Ozturk
Budak, Ferah
Pekgoz, Murat
Korkmaz, Serhat
Karkucak, Mutlu
Ozcelik, Tulay
Tunali, Ahmet
description Imatinib has shown significant clinical and cytogenetic success in the treatment of chronic myeloid leukemia. Although resistance has been observed in a proportion of patients, sudden blastic crisis is a rare event during imatinib therapy. We describe a 24-year-old male patient with Philadelphia chromosome-positive chronic myeloid leukemia in chronic phase who developed sudden blastic crisis in the 24th month of imatinib therapy, with loss of complete cytogenetic response. At this time, the patient had splenomegaly, severe anemia, thrombocytopenia, and leukocytosis. Bone marrow aspirate revealed the presence of massive blastic infiltration with myeloid morphology. Flow cytometric analysis of the bone marrow cells showed positivity for CD45, CD34, CD13, CD33, CD19, CD41, CD61, and glycophorin-A. Trephine biopsy specimens showed 100% cellular marrow with diffuse infiltrate by blasts. A reticulin stain of the bone marrow biopsy section demonstrated severe diffuse fibrosis. Cytogenetic analysis by fluorescence in situ hybridization (FISH) revealed that 92% of the cells were positive for the BCR/ABL fusion signal and had increased copy numbers for chromosomes 8, 13, 19, and 21. The patient’s prognosis was unfavorable. In conclusion, chronic myeloid leukemia remains complex and includes unanswered questions. The presented case with a rare event during imatinib therapy highlights the need for the continued monitoring of residual disease and the development of strategies to eliminate residual leukemia cells in patients showing a complete cytogenetic response.
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subjects Adult
Antineoplastic Agents - therapeutic use
Benzamides
Blast Crisis - diagnosis
Blast Crisis - pathology
Cancer Research
Case Report
Case studies
Chromosome Aberrations
Cytogenetic Analysis
Cytogenetics
Drug therapy
Humans
Imatinib Mesylate
In Situ Hybridization, Fluorescence
Leukemia
Leukemia, Myelogenous, Chronic, BCR-ABL Positive - diagnosis
Leukemia, Myelogenous, Chronic, BCR-ABL Positive - drug therapy
Leukemia, Myelogenous, Chronic, BCR-ABL Positive - pathology
Male
Medicine
Medicine & Public Health
Oncology
Piperazines - therapeutic use
Pyrimidines - therapeutic use
Surgical Oncology
title Sudden blastic crisis and additional chromosomal abnormalities during chronic myeloid leukemia in the imatinib era
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