Philadelphia-positive T-cell acute lymphoblastic leukemia with polymyositis, migratory polyarthritis and hypercalcemia following a chronic myeloid leukemia

Lima, Margarida; Coutinho, Jorge; Bernardo, Lindsay A.; Teixeira, Maria dos Anjos; Casais, Cláudia; Canelhas, Áurea; Queirós, Maria Luı́s; Órfão, Alberto; Justiça, Benvindo

doi:10.1007/s00277-001-0422-7

Cited by 14 publications

(9 citation statements)

References 32 publications

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“…The appearance of blasts in the bone marrow may lag behind [34]. Although extramedullary disease developed more frequently in lymph nodes, extranodal masses have also been described [11, 27, 35]. Similar to the Ph1-positive T-ALL cases, the prognosis was also grave with only 8 patients alive and 23 dead at the time of the report.…”

Section: Discussionmentioning

confidence: 62%

Philadelphia-Chromosome-Positive T-Lymphoblastic Leukemia: Acute Leukemia or Chronic Myelogenous Leukemia Blastic Crisis

et al. 2005

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The Ph1 chromosome has rarely been reported in T-lineage acute lymphoblastic leukemia (T-ALL), and the clinical relevance of this translocation in T-ALL is currently unknown. In chronic myelogenous leukemia (CML) some data indicate derivation of T-cells from the leukemic clone and only a few cases of T-derived blastic crisis have been reported and quite often disputed. Particularly in cases identified initially in blastic crisis it may be difficult to distinguish those from Ph1-positive T-ALL. We herein report 2 patients who presented with a clinical picture of Ph1-positive T-ALL and who raised a differential diagnosis from T-cell blastic crisis of CML. We review the literature and suggest clinical and laboratory features that can help in the diagnosis. According to our literature review, 23 cases of Ph1-positive T-ALL and 44 cases of T-cell blastic crisis of CML, including ours, were reported. Some major differences between the two entities could help in establishing a diagnosis of Ph1-positive T-cell blastic crisis of CML vs. Ph1-positive T-ALL: Male sex and younger age was more predominant in T-ALL. While in most cases of CML blastic crisis there was a history of CML there was no such history in the T-ALL cases. Medullary involvement with lymphoblastic leukemia was present in all cases of T-ALL but only in about half of the cases of CML blastic crisis. None of the CML-blastic crisis cases tested by RT-PCR showed the minor breakpoint transcript, while 2 cases with T-ALL had the minor breakpoint transcript and 1 had both transcripts. Combined morphologic and FISH analysis can help to distinguish between the two entities and was applied in one of our cases. Although both entities carry a severe prognosis, differentiating between them might have clinical relevance, especially in the imatinib era.

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Section: Discussionmentioning

confidence: 62%

Philadelphia-Chromosome-Positive T-Lymphoblastic Leukemia: Acute Leukemia or Chronic Myelogenous Leukemia Blastic Crisis

et al. 2005

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“…6,7,12 Paraneoplastic arthritis is rare, of unknown origin, and has been reported in different types of neoplasms, including acute lymphoblastic leukemia. [25][26][27] Seleznick et al 5 suggest that reactive phenomena directed to neoplastic T-cell proliferation may play a role in MF-associated polyarthritis. The joint symptoms are commonly asymmetric, nonerosive, and tend to spare the small joints of the hands and wrists.…”

Section: Discussionmentioning

confidence: 99%

Clonal identity between skin and synovial tissue in a case of mycosis fungoides with polyarthritis

Sandberg¹,

Abdouni²,

Lam³

et al. 2004

Journal of the American Academy of Dermatology

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“…(2001) [16]78/F4–5 monthsBPHydration, PRED, diuretic, pamidronateVCR, adriamycinRapid CR; died 1 month laterLima et al . (2002) [25]35/F2 yearsBPPRED, pamidronateCyclophosphamide, DOX, VCRCR in 1 week; died 1 month laterMiyoshi et al . (2005) [14]68/F4 yearsBPPRED, diuretic, incadronate, elcatoninEnocitabine, DAU, VCRCR; died 8 months laterNoguchi and Oshimi (2007) [26]66/M10 yearsBPHydration, PRED, bisphosphonate, elcatoninVCRCR in 3 weeks; died 8 weeks after admissionValizadeh et al .…”

Section: Discussionmentioning

confidence: 99%

Leukemic arthritis and severe hypercalcemia in a man with chronic myeloid leukemia: a case report and review of the literature

et al. 2018

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BackgroundPatients with chronic myeloid leukemia typically present with high white blood cell counts revealed during annual checkups. Leukemic arthritis and hypercalcemia are rare manifestations in patients with chronic myeloid leukemia.Case presentationA 35-year-old Thai man who had been diagnosed with chronic myeloid leukemia in the chronic phase developed blast crisis while he was receiving ongoing treatment with imatinib at 400 mg/day. Initially, he presented with oligoarthritis in both knees and ankles. A bone scintigraphy showed a prominent bony uptake, with a symmetrical, increased uptake in many bone areas. Induction therapy with a 7 + 3 induction regimen was prescribed in conjunction with 600 mg of imatinib once daily before switching to 140 mg of dasatinib. He subsequently developed severe hypercalcemia (total serum calcium of 17.8 mg/dL), with generalized osteolytic lesions detected on a bone survey. His serum vitamin D level was 50.64 ng/mL, while the serum parathyroid hormone level was 9.82 pg/mL. Despite the administration of an aggressive intravenously administered hydration, intravenously administered calcitonin, and 600 mg/day of imatinib, the severe hypercalcemia was refractory. We therefore decided to prescribe 20 mg/day of intravenously administered dexamethasone; fortunately, his serum calcium level decreased dramatically to normal range within a few days.ConclusionsAlthough leukemic arthritis and severe hypercalcemia are extraordinary presentations in patients with chronic myeloid leukemia, the advanced phase of the disease might bring on these symptoms. Apart from parathyroid hormone-related protein-related hypercalcemia, vitamin D is a mechanism of humoral-mediated hypercalcemia.Electronic supplementary materialThe online version of this article (10.1186/s13256-018-1798-5) contains supplementary material, which is available to authorized users.

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Philadelphia-positive T-cell acute lymphoblastic leukemia with polymyositis, migratory polyarthritis and hypercalcemia following a chronic myeloid leukemia

Cited by 14 publications

References 32 publications

Philadelphia-Chromosome-Positive T-Lymphoblastic Leukemia: Acute Leukemia or Chronic Myelogenous Leukemia Blastic Crisis

Philadelphia-Chromosome-Positive T-Lymphoblastic Leukemia: Acute Leukemia or Chronic Myelogenous Leukemia Blastic Crisis

Clonal identity between skin and synovial tissue in a case of mycosis fungoides with polyarthritis

Leukemic arthritis and severe hypercalcemia in a man with chronic myeloid leukemia: a case report and review of the literature

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