SHM Converge Scientific Abstract ePoster Gallery-Atypical Presentation of Chronic Myeloid Leukemia in Lymphoid Blast Crisis

Pdf Summary

This case report describes an atypical presentation of chronic myeloid leukemia (CML) in lymphoid blast crisis. CML is a hematologic malignancy classically associated with the Philadelphia chromosome t(9;22) and the BCR-ABL fusion oncogene. Most cases are discovered incidentally through routine bloodwork showing marked leukocytosis, but this patient presented instead with progressive forgetfulness and nonspecific neurologic complaints.<br /><br />The patient was a 61-year-old man with a history of factor V Leiden mutation, hypothyroidism, and prior transient ischemic attacks. Over the preceding year, he had repeated episodes of forgetting why he had come to appointments or what he had been doing. Workup for other causes was unrevealing, including normal thiamine and B12 levels, a negative paraneoplastic panel, negative infectious studies, a normal MRI of the brain and spinal cord, and an unremarkable CT scan of the chest, abdomen, and pelvis. Physical exam showed a coarse tremor and subjective sensory loss, but no focal deficits.<br /><br />Laboratory findings showed only mild leukocytosis with slight basophilia, which was an important clue. Peripheral smear demonstrated left shift with immature myeloid forms and atypical lymphoid cells. Bone marrow biopsy was hypercellular and packed with blasts. Flow cytometry showed 60% lymphoid blasts positive for CD10 and CD19, and immunostains were strongly positive for CD10 and CD34. Cytogenetics revealed the Philadelphia chromosome, and molecular testing identified the p210 BCR-ABL oncoprotein.<br /><br />Although the initial impression was Philadelphia chromosome–positive B-ALL, the presence of p210 favored CML in lymphoid blast crisis. The report emphasizes that advanced cytogenetic and molecular testing is essential to distinguish these entities, especially because treatment implications differ, particularly in pediatric and transplant considerations.

Asset Subtitle

Biplov Adhikari

Meta Tag

Author List Amrit Paudel, Anaam Mubin, Biplov Adhikari

Category Clinical Vignettes

Concept Chronic Myeloid Leukemia

Concept Philadelphia Chromosome

Concept BCRABL1 Fusion

Concept p210 Oncoprotein

Concept Lymphoid Blast Crisis

Distinguished Non-Finalist

Presenter Organization MedStar Health, Baltimore

Presenting Author Biplov Adhikari

Track Adult

Keywords

chronic myeloid leukemia

lymphoid blast crisis

Philadelphia chromosome

BCR-ABL fusion

p210 BCR-ABL

leukocytosis

bone marrow biopsy

flow cytometry

CD10 CD19

atypical presentation

Chronic Myeloid Leukemia

Philadelphia Chromosome

BCRABL1 Fusion

p210 Oncoprotein

Lymphoid Blast Crisis