Myeloid Blast Crisis of Chronic Myeloid Leukemia Followed by Lineage Switch to B-Lymphoblastic Leukemia: A Case Report

Figures & data

Table 1 Laboratory Data on First Admission

CBC		Chemistry		Bone Marrow
WBC	573,090/μL	LDH	1125U/L	M/E	96.50
Blasts	17%	AST	11U/L	Blasts	25%
Promyelocytes	14%	ALT	36U/L	Promyelocytes	13%
Myelocytes	14%	GGT	64U/L	Myelocytes	5%
Metamyelocytes	11%	TB	11.1µmol/L	Metamyelocytes	6%
Stabs	17%	TP	64.3g/L	Stabs	16%
Segmented	21%	Na	141.2mmol/L	Segmented	26%
Eosinophils	3%	K	3.18mmol/L	Eosinophils	3%
Basophils	2%	Cl	98.7mmol/L	Basophils	2%
Monocytes	0%	UREA	7.48 mmol/L	Monocytes	0.5%
Lymphocytes	1%	Creatinine	80 µmol/L	Lymphocytes	2%
RBC	195×10 ^4/μL	D - dimer	912ng/mL	Karyotype	46,XY,t(9;22)(q34;q11.2)
Hemoglobin	71g/L	–	–	Major BCR-ABL mRNA	8.14×10^4copies/μg RNA
PLT	4.3×10^4/μL	–	–	–	–

Abbreviations: CBC, complete blood cell count; WBC, white blood cells; RBC, red blood cells; PLT, platelets; LDH, lactate dehydrogenase; AST, alanine aminotransferase; ALT, aspartate aminotransferase; GGT, glutamyltranspeptidase; TB, total bilirubin; TP, total protein; Na, sodium; K, potassium; Cl, chlorine; M/E, myeloid to erythroid ratio.

Table 2 Laboratory Data on Second Admission

CBC		Chemistry		Bone Marrow
WBC	48,380/μL	AST	62U/L	M/E	5.89
Blasts	4%	ALT	27U/L	Blasts	62.5%
Promyelocytes	0%	GGT	133U/L	Promyelocytes	0%
Myelocytes	6%	TB	12.3µmol/L	Myelocytes	1.5%
Metamyelocytes	10%	TP	69.3g/L	Metamyelocytes	4.5%
Stabs	16%	Na	132.2mmol/L	Stabs	9.5%
Segmented	47%	K	3.56 mmol/L	Segmented	11%
Eosinophils	1%	Cl	92.5mmol/L	Eosinophils	0%
Basophils	1%	UREA	3.66 mmol/L	Basophils	0%
Monocytes	7%	Creatinine	64µmol/L	Monocytes	1.0%
Lymphocytes	8%	D - dimer	948ng/mL	Lymphocytes	5.5%
RBC	364×10 ^4/μL	–	–	Karyotype	46,XY,t(9;22)(q34;q11)
Hemoglobin	112g/L	–	–	Major BCR/ABL mRNA	2.35×10^5copies/μg RNA
PLT	1.0×10^4/μL	–	–	–	–

Abbreviations: CBC, complete blood cell count; WBC, white blood cells; RBC, red blood cells; PLT, platelets; LDH, lactate dehydrogenase; AST, alanine aminotransferase; ALT, aspartate aminotransferase; GGT, glutamyltranspeptidase; TB, total bilirubin; TP, total protein; Na, sodium; K, potassium; Cl, chlorine; M/E, myeloid to erythroid ratio.

Figure 1 Bone marrow aspirate (1000×) using wright stain and chromosome study on first admission. (A) A BM study revealed acute myeloid leukemia. (B) A chromosome study revealed a karyotype of 46, XY, t(9; 22)(q34; q11) in all 20 cells analyzed.

Figure 2 Immunophenotyping by flow cytometry of the blasts at acute myeloid leukemia phase.

Figure 3 Bone marrow aspirate (1000×) using Wright stain and chromosome study on second admission. (A) A BM study revealed acute B-lymphoid leukemia. (B) A chromosome study revealed a karyotype of 46, XY, t(9; 22)(q34; q11) in all 20 cells analyzed.

Figure 4 Immunophenotyping by flow cytometry of the blasts at acute B-lymphoid leukemia phase.