Promyelocytic Blast Crisis of Chronic Myelogenous Leukemia during Imatinib Treatment

Gozzetti, Alessandro; Bocchia, Monica; Calabrese, Simona; Pirrotta, Maria Teresa; Crupi, Rosaria; Raspadori, Donatella; Lauria, Francesco

doi:10.1159/000099548

Cited by 10 publications

(7 citation statements)

References 5 publications

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“…In the myeloid phenotype, blasts can be neutrophilic, eosinophilic, basophilic, monocytic, megakaryocytic, or erythroid [4][5][6]. Rarely, cases of T-lymphoid and promyelocytic-BP have been documented [7,8] and they are even more rare during TKI treatment [9,10]. Looking at gene expression profiling during the evolution, the progression from CP to advanced phases has been described as a two-step rather than a three-step process.…”

Section: Introductionmentioning

confidence: 99%

Mechanisms of Disease Progression and Resistance to Tyrosine Kinase Inhibitor Therapy in Chronic Myeloid Leukemia: An Update

Bavaro

Martelli

Cavo

et al. 2019

IJMS

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Chronic myeloid leukemia (CML) is characterized by the presence of the BCR-ABL1 fusion gene, which encodes a constitutive active tyrosine kinase considered to be the pathogenic driver capable of initiating and maintaining the disease. Despite the remarkable efficacy of tyrosine kinase inhibitors (TKIs) targeting BCR-ABL1, some patients may not respond (primary resistance) or may relapse after an initial response (secondary resistance). In a small proportion of cases, development of resistance is accompanied or shortly followed by progression from chronic to blastic phase (BP), characterized by a dismal prognosis. Evolution from CP into BP is a multifactorial and probably multistep phenomenon. Increase in BCR-ABL1 transcript levels is thought to promote the onset of secondary chromosomal or genetic defects, induce differentiation arrest, perturb RNA transcription, editing and translation that together with epigenetic and metabolic changes may ultimately lead to the expansion of highly proliferating, differentiation-arrested malignant cells. A multitude of studies over the past two decades have investigated the mechanisms underlying the closely intertwined phenomena of drug resistance and disease progression. Here, we provide an update on what is currently known on the mechanisms underlying progression and present the latest acquisitions on BCR-ABL1-independent resistance and leukemia stem cell persistence.

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Section: Introductionmentioning

confidence: 99%

Mechanisms of Disease Progression and Resistance to Tyrosine Kinase Inhibitor Therapy in Chronic Myeloid Leukemia: An Update

Bavaro

Martelli

Cavo

et al. 2019

IJMS

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“…Genomic instability and less vulnerability of CML stem cell to imatinib may cause to CML progression in a little time. Although imatinib mesylate was used by the patient whom BCR-ABL suppressed or undergo apoptosis while leukemic cells developed to clonal evaluation [5].…”

Section: Discussionmentioning

confidence: 99%

“…Promyelocytic blastic crisis of CML is highly rare, accounting for about 30 cases searching English literature before 2007 [5]. The first case with promyelocytic blastic crisis during Imatinib mesylate therapy was published by Gozetti et al [6] who is 50 years old male patient.…”

Section: Discussionmentioning

confidence: 99%

Presentation of chronic myeloid leukemia as promyelositic blastic transformation: A case report and literature review

Abiyev¹,

Zengin²,

Önder³

et al. 2017

Clin Case Rep Rev

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Chronic myelocytic leukemia (CML) is a clonal disorder involving the pluripotent stem cell and is consistently associated with the BCR-ABL1 fusion gene located on the Philadelphia chromosome. The disease typically evolves in 3 distinct clinical stages: chronic and accelerated phases and blast crisis. The promyelocytic blast crisis is a rare form of transformation during the evolution of CML. Here we report a case of promyelocytic blastic crisis with t(15;17) in addition to t(9;22).

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“…A thorough literature review has revealed only two cases of promyelocytic blast crisis during treatment with a TKI. The first occurred in a 66-year-old woman with CML, nine months into treatment, and the other in a 50-year-old man, 12 months into treatment [1,3]. We present here a case of acute promyelocytic leukemia (APL) with associated disseminated intravascular coagulation (DIC) which developed two years into bosutinib treatment in a patient with chronic phase CML.…”

Section: Introductionmentioning

confidence: 99%

“…The promyelocytic blast crisis of CML is an extremely rare occurrence. In literature, there are only a limited number of such cases, dating as far back as 1986 [1,2]. A thorough literature review has revealed only two cases of promyelocytic blast crisis during treatment with a TKI.…”

Section: Introductionmentioning

confidence: 99%

Promyelocytic Blast Crisis of Chronic Myeloid Leukemia in a Patient Undergoing Therapy with a Tyrosine Kinase Inhibitor

Parsi

Budak‐Alpdoğan

2020

Cureus

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A 58-year-old male with the chronic phase of chronic myeloid leukemia (CML), treated with a tyrosine kinase inhibitor (TKI), bosutinib, since the past two years, presented with bright red bleeding per rectum and disseminated intravascular coagulation. A bone marrow biopsy reverse transcription-polymerase chain reaction revealed a promyelocytic blast crisis, with leukemic cells displaying both BCR/ABL and PML/RARα chimeric genes. Cytogenetic studies revealed translocations of both t(15;17) and t(9;22). With the initiation of all-trans retinoic acid, arsenic trioxide and gemtuzumab, the patient achieved remission, with absent PML/RARα by fluorescence in situ hybridization analysis. This case highlights the importance of long-term monitoring of patients with CML, especially those on TKIs, for the development of secondary leukemias in the future.

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Promyelocytic Blast Crisis of Chronic Myelogenous Leukemia during Imatinib Treatment

Cited by 10 publications

References 5 publications

Mechanisms of Disease Progression and Resistance to Tyrosine Kinase Inhibitor Therapy in Chronic Myeloid Leukemia: An Update

Mechanisms of Disease Progression and Resistance to Tyrosine Kinase Inhibitor Therapy in Chronic Myeloid Leukemia: An Update

Presentation of chronic myeloid leukemia as promyelositic blastic transformation: A case report and literature review

Promyelocytic Blast Crisis of Chronic Myeloid Leukemia in a Patient Undergoing Therapy with a Tyrosine Kinase Inhibitor

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