T-Cell Blast Crisis in Chronic Myeloid Leukemia

Hypercalcemia is a rare complication of chronic myeloid leukemia (CML), usually seen in the accelerated or blastic phases of the disease and associated with a poor prognosis. T-cell lymphoid phenotype is also an infrequent finding in the blast crisis (BC) of CML. A CML patient who had hypercalcemia as the presenting feature of a T-cell BC is reported. She was a 78 year-old woman who, at four months of CML diagnosis, developed weakness, bone pain, and mental confusion, with hypercalcemia being subsequently found. Although the peripheral blood and bone marrow were consistent with the chronic phase of CML, mediastinal enlargement, a soft tissue mass adjacent to the iliac bone, and multiple osteolytic lesions were seen. Serum levels of parathyroid hormone (PTH) and PTH-related peptide were normal, whereas the search for a second neoplasm was negative. The hypercalcemia initially responded to conventional treatment, but it reappeared two weeks later. Coincidentally, a high proportion of blast cells of T-cell origin at the cortical thymocyte stage were observed in the patient's peripheral blood and bone marrow, and she died shortly afterwards.

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Hypercalcemia as the Presenting Feature of T-Cell Lymphoid Blast Crisis of Ph-Positive Chronic Myeloid Leukemia

Nadal

Cervantes

Rosiñol

et al. 2001

Leukemia & Lymphoma

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Lack of Involvement of T-Lymphocytes in the Leukaemic Population During: Prolonged Chronic Phase of Philadelphia Chromosome Positive Chronic Myeloid Leukaemia

Ariad¹,

Dajee²,

Willem³

et al. 1993

Leukemia & Lymphoma

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Nine patients with prolonged (> 2 years) chronic phase chronic myeloid leukaemia (CML) were investigated for the presence of T-cell involvement in the leukemic clone. Pure populations of peripheral blood T-cell populations were obtained by culturing separated mononuclear cells in the presence of pokeweed mitogen and IL2, until cultures showed > 99% pure T-cells. Purified T-cells and bone marrow and peripheral blood hematopoietic precursors were analysed for the presence of bcr-abl mRNA transcripts following RNA extraction and message amplification using polymerase chain reaction. In none of the 9 patients was bcr-abl mRNA found in T-lymphocytes while in all cases such transcripts were found in bone marrow and peripheral blood hematopoietic cells. Failure to detect T-cell involvement in patients with prolonged chronic phase CML using techniques designed to enhance even low level involvement of these cell populations supports the view that acquisition of the Ph chromosome abnormality does not occur in the totipotent stem cells but in more committed precursor cell/s with multilineage capacity but which only rarely retain the capacity for T-cell differentiation.

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T-Cell Blast Crisis in Chronic Myeloid Leukemia

Cited by 2 publications

References 27 publications

Hypercalcemia as the Presenting Feature of T-Cell Lymphoid Blast Crisis of Ph-Positive Chronic Myeloid Leukemia

Hypercalcemia as the Presenting Feature of T-Cell Lymphoid Blast Crisis of Ph-Positive Chronic Myeloid Leukemia

Lack of Involvement of T-Lymphocytes in the Leukaemic Population During: Prolonged Chronic Phase of Philadelphia Chromosome Positive Chronic Myeloid Leukaemia

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