An interesting case of chronic myeloid leukemia presenting as B-cell lymphoblastic crisis

Abstract

We present the case of a 46-year-old male patient who came to our emergency department in December 2019 for pain in the left abdominal quadrant. The patient had no fever, night sweats or a history of weight loss. The la­bo­ra­tory tests revealed important leucocytosis and the ab­do­mi­nal ul­tra­sound highlighted a massive sple­no­me­ga­ly. He was hos­pi­ta­lized for further investi­ga­tions. We performed all the necessary laboratory tests to establish the diagnosis of the patient. Even though the osteomedullar biopsy and the flow cytometry suggested the diagnosis of acute B-cell lymphoblastic leukemia, the fluorescence in situ hybri­di­za­tion exam – the translocation t(9;22) was present in 100% of the analyzed cells – and the detection of BCR-ABL1 b2a2 trans­cript established the diagnosis of chronic myeloid leu­ke­mia, B-cell lymphoblastic crisis. We decided to start the treat­ment with the GRAAPH 2005 pro­to­col associated with ima­ti­nib, and the patient was a candidate for allogeneic trans­plan­ta­tion. We chose to pre­sent this case because the pa­tient was young, without sig­ni­fi­cant comorbidities, with chronic myeloid leukemia – B-cell lymphoblastic crisis as the initial diagnosis, whose evo­lu­tion was negative, despite his favorable prognosis.