Very Late Relapse of Chronic Myelogenous Leukemia Following Stem Cell Transplant

Abstract

Chronic myelogenous leukemia (CML) is a myeloproliferative neoplasm of the bone marrow that is associated with the Philadelphia chromosome, which creates the fusion BCR-ABL tyrosine kinase. Prior to development of tyrosine kinase inhibitors such as imatinib, the standard of care for treatment in certain clinical situations was hematopoietic stem cell transplant. We present a case of a 61 year-old male with a history of CML who received a stem cell transplant 20 years prior. He now had developed an increased white blood cell count and was found to have recurrence of CML in his bone marrow and via peripheral blood analysis for BCR-ABL. Through further evaluation it was found that the recurrence was genetically the same as his original malignancy and not a de novo evolution of his sibling donor graft cells. He was trialed on several tyrosine kinase inhibitors following his diagnosis but had complications with one and progression on another. He was eventually given a donor leukocyte infusion to combat his disease which improved his status and was without complication. This case demonstrates a rare but known entity of very later recurrence of CML following stem cell transplant.