CHRONIC MYELOGENEOUS LEUKEMIA TRANSFORMATION INTO ACUTE LYMPHOBLASTIC LEUKEMIA

Introduction : Chronic myelogeneous leukemia (CML) is a myeloproliferative neoplasm that can progress into various conditions. Transformation of CML into acute lymphoblastic leukemia (ALL) is a rare case. Case : A 22-year-old male with history of CML since 2014 and positive BCR-ABL p210 in 2017 came with complaint of weakness. Physical examination showed hepatosplenomegaly. CBC results Hb 7.1 g/dL, WBC 290,620/μL, platelet 434,000/μL. Blood smear evaluation (BSE) suggested CML blastic crisis dd AML-M5. Patient’s condition got worse. CBC result showed WBC 96,770/μL and platelet 7,000/μL in 2 weeks later. BSE was dominated by mononuclear cells with scanty blue cytoplasm, no granules, no auer rods, loose chromatine and indistinct nucleoli, suggesting lymphoblasts with a proportion of 60%. Bone marrow aspiration (BMA) and immunophenotyping was done to confirm BSE. The BMA result was dominated by lymphoblast, consistent with ALL. The immunophenotyping result was CD10+, CD34+(0,99%), CD79a+, HLA-DR+, and CD20+. Molecular examination showed positive RUNX1 and NRAS while negative FLT3, NPM1 and del(5q). Discussion : BCR-ABL gene can be found both in CML and ALL. CML transformation into ALL had been reported to be related with deletion of a transcription gene. Diagnosis of ALL can be established by BMA and immunophenotyping. CD34+ expression of lymphoblast in ALL can be varied, but in this case was minimal. Conclusion : Patient with history of CML showed an ALL picture based on BSE, BMA and immunophenotyping suggesting CML transformation into ALL although CD34+ expression was minimal.

Bone Marrow Beta-Catenin Expression In Chronic Myelogenous Leukemia Patients Treated With Imatinib

Background Imatinib is the standard of care for treating chronic myelogeneous leukemia (CML). However, it is rarely curative and patients often show resistance to the drug. ABL-kinase domain mutations are one mechanism of resistance in CML. Regulation of hematopoietic stem cell survival, as well as disease progression in CML has been linked to the Wnt/beta-catenin pathway. Our study investigated the expression of beta-catenin in the bone marrow (BM) of CML patients treated with imatinib as well as its possible application as a prognostic marker for response to therapy.

Role of Hydroxyurea in Psoriasis - A Review

Most of the patients of psoriasis have a chronic course withthe need for continuous control of disease activity. Patientswith moderate-to-severe disease generally requirephototherapy, photo-chamotherapy or systemic agents (e.g.cyclosporine, methotrexate, oral retinoids, fumaric acidesters) to control their disease adequately. In general thesetherapeutic modalities have proven to be highly effective inthe treatment of psoriasis. However, potentially serious toxicitycan limit their long term use. In this respect, hydroxyureacompares favourably with methotrexate which has a potentialfor producing irreversible hepatic damage and cyclosporineA with its potential for dose-related nephrotoxicity.Hydroxyurea, a hydroxylated molecule of urea is commonlyused to treat chronic myelogeneous leukemia andpolycythemia vera. Recent studies suggest it as an alternativeto methotrexate in moderate-to-severe psoriasis. DOI: http://dx.doi.org/10.3329/jbcps.v29i4.11330 J Bangladesh Coll Phys Surg 2011; 29: 219-226