An unusual case of T-cell acute lymphoblastic leukemia in a patient with BCR-ABL positive chronic myeloid leukemia and Gaucher disease
Date
2021-08-20
Authors
Al-Janazreh, Hamdi
Abuzneid, Yousef S.
Khamayseh, Iman
Morabito, Fortunato
Alqam, Bilal
Abusabbah, Rosaline M.F.
Mustafa, Fatima K.
Sarahneh, Shifa
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
Abstract
Background: Chronic myelogenous leukemia (CML) is a chronic myeloproliferative disease characterized by a
massive overproduction of myeloid cells. It is associated with the Philadelphia chromosome [Ph1, t (9; 22) (q34;
q11)] or BCR-ABL fusion gene. CML usually undergoes a triphasic clinical course ending in a blast crisis, an
accelerated phase of blasts and promyelocyte production. Ten percent of CML patients reach the blast crisis
phase, with 20–30% of leukemias belonging to B-cell lymphoid lineage. However, a transformation of CML into
T-cell acute lymphoblastic leukemia (T-ALL) is rare.
Case presentation: We present a 56-year-old male patient, known case of hypertension and Ph1 CML of eight years
with a family history of Gaucher disease who developed T-ALL. The patient presented with lymphadenopathy
and severe anemia, needing packed RBC transfusion, neutropenia and thrombocytopenia at the admission.
However, the monocytes and basophils percentage were high. The patient underwent a cervical lymph node core
biopsy, and the immunohistochemistry stains showed an invasion of neoplastic cells positive for CD3, CD5, BCL2,
CD34, TdT and focally positive for C-Kit and negative for CD20, CD56 and pan-CK. These histopathology features
were consistent with T-cell acute lymphoblastic leukemia (T-ALL).
Conclusion: Blast crisis remain a challenge in CML management. It’s of great importance to do a full proper
workup including lymph nodes biopsies. The aim is to reverse blast crisis and restore the chronic phase.
Description
Keywords
CML , T-ALL , Blast crisis , Transformation , Case report