Promyelocytic Crisis of Chronic Myelogenous Leukaemia during Imatinib Mesylate Treatment

Abstract

An untreated 66-year-old woman with chronic myelogenous leukaemia (CML) in the chronic phase was initially given imatinib mesylate, rapidly achieving a good cytogenetic response with treatment. However, acute promyelocytic leukaemia complicated by a disseminated intravascular coagulation occurred 9 months after beginning imatinib treatment. Promyelocytic crisis of CML was diagnosed by demonstration of both BCR/ABL and PML/RARα chimeric genes in leukaemic cells by karyotypic and fluorescence in situ hybridization analysis. Clonal evolution with addition of the PML/RARα translocation may have arisen in the early chronic phase of CML, with expansion of this clone during imatinib treatment. Promyelocytic crisis of CML is rare; furthermore, we know of no previous report of promyelocytic crisis occurring during treatment with imatinib.

Promyelocytic Blast Crisis of Chronic Myelogenous Leukemia during Imatinib Treatment

“…BCR-ABL fusion was detected in 95, 3, 1, 0, and 91% of cells respectively, while PML-RARa fusion was always found negative. This is in contrast with the findings of Oku et al [1] since they found the presence of a PML/ RARa transcript in 6.8% of the cells 2 months before BC. Our patient had neither measurable BCR-ABL nor other cytogenetic aberration before BC.…”

“…Thus, our patient showed only a molecular PML-RARa rearrangement, absent at conventional cytogenetic analysis, compared to the patient described by Oku et al [1] in whom a t(15; 17) was evident. We also retrospectively analyzed bone marrow samples by FISH utilizing BCR-ABL and PML-RARa probes at 0, 3, 6, 9, and 12 months from diagnosis.…”

“…However, recent advances in our understanding of leukemia stem cell biology and emerging data about imatinib-resistant CML and BCR-ABL-related genomic instability have led to new assumptions [2] . BCR-ABL is directly or indirectly responsible for progressive genomic instability or epigenetic changes which occur at the CML stem cell level or in later CML proWe read with great interest the recent paper of Oku et al [1] about a promyelocytic blast crisis (BC) of chronic myelogenous leukemia (CML) during imatinib treatment. As the authors correctly reported, this is a very rare event in CML.…”

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

“…The most commonly seen chromosomal abnormalities were trisomy 8, deletions and translocations chromosomes 9, 7, 21 and 17 [8]. Rosenthal et al [9] in a series of 89 cases of blast crisis of CML found two cases classified as APL. The two of CML revealed t(15;17) in addition to t(9;22).…”

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

“…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.…”