Chronic myeloid leukemia presenting in lymphoblastic crisis, a differential diagnosis with Philadelphia-positive B-lymphoblastic leukemia.
Rare patients with chronic myeloid leukemia (CML) can present initially in lymphoblastic crisis (LBC) mimicking Ph + B-lymphoblastic leukemia (B-ALL). We retrospectively reviewed 275 adults who diagnosed initially as Ph + B-ALL and identified 28 patients with at least one of three features supporting the diagnosis of CML-LBC: 1) a large discrepancy between the blast count and Ph + clone; 2) Ph + clone persistent when B-ALL in remission; 3) BCR/ABL1 fusion detected in segmented cells. BCR-ABL1 fusions were p210 in 25 patients and p190 in 3 patients. In comparison to patients with Ph + B-ALL, patients with CML-LBC were older; had higher leukocyte and absolute neutrophil counts; higher immature myeloid cells in peripheral blood; lower blast counts; and inferior outcomes. In addition, we prospectively analyzed 26 patients with Ph + B-lymphoblastic leukemia and identified 8 patients with features more consistent with CML-LBC. These findings highlight the importance of distinguishing CML-LBC from de novo Ph + B-ALL.
['Chen|Zhining|Z|', 'Hu|Shimin|S|', 'Wang|Sa A|SA|', 'Konopleva|Marina|M|', 'Tang|Zhenya|Z|', 'Xu|Jie|J|', 'Li|Shaoying|S|', 'Toruner|Gokce|G|', 'Thakral|Beenu|B|', 'Medeiros|L Jeffrey|LJ|', 'Tang|Guilin|G|0000-0002-9482-4806']
D000328:Adult D001752:Blast Crisis D003937:Diagnosis, Differential D016044:Fusion Proteins, bcr-abl D006801:Humans D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive D010677:Philadelphia Chromosome D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma D012189:Retrospective Studies
Chronic myeloid leukemia lymphoblastic crisis B-lymphoblastic leukemia Philadelphia chromosome