[ Transformation d’une leucémie myéloïde chronique (LMC) en Leucémie aigue mégacaryoblastique: A propos d’un cas ]
Volume 39, Issue 2, April 2023, Pages 719–723
Zineb Karouchi1, Hanae Bencharef2, Aya Rachidi3, and Bouchra Oukkache4
1 Laboratoire d’hématologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
2 Hematology Laboratory, Ibn Rochd University Hospital of Casablanca, Morocco
3 Laboratoire d’hématologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
4 Hematology Laboratory, Ibn Rochd University Hospital of Casablanca, Morocco
Original language: French
Copyright © 2023 ISSR Journals. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The acute transformation of chronic myeloid leukemia has become a rare event since the introduction of tyrosine kinase inhibitors. Less than 3% of patients with CML transform to a megakaryoblastic leukemia. The diagnosis represents a challenge, due to the frequent association with myelofibrosis, thus requiring an osteo-medullar biopsy to confirm the diagnosis. We report the case of a megacaryoblastic blast crisis associated with myelofibrosis in a CML young female patient. A 32-year-old woman previously diagnosed with CML in chronic phase, on Tyrosine kinase inhibitors, presents with a clinical bone marrow failure. Blood counts showed pancytopenia. A peripheral blood smear revealed the presence of 30% blast cells, with a round nuclei, prominent nucleoli, and a very basophilic cytoplasm with cytoplasmic blebs. The diagnosis of a blast crisis in CML was retained. Bone marrow aspiration was practiced twice, and came back poor both times. A bone marrow biopsy practiced later confirming the diagnosis of acute leukemia associated to myelofibrosis. Immunophenotyping by flow cytometry was performed on peripheral bood, and revealed a blast population (76%) positive for CD45 (mild) and expressing the following markers CD33, CD34, CD41 and CD61, confirming the diagnosis of acute megacaryoblastic leukemia. Based on clinical presentation, bone marrow findings and flow cytometry, the diagnosis of CML with megakaryoblastic crisis associated to myelofibrosis at a 32-year-old woman was retained.
Author Keywords: Acute megakaryocytic leukemia, blast crisis, chronic myeloid leukemia.
Volume 39, Issue 2, April 2023, Pages 719–723
Zineb Karouchi1, Hanae Bencharef2, Aya Rachidi3, and Bouchra Oukkache4
1 Laboratoire d’hématologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
2 Hematology Laboratory, Ibn Rochd University Hospital of Casablanca, Morocco
3 Laboratoire d’hématologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
4 Hematology Laboratory, Ibn Rochd University Hospital of Casablanca, Morocco
Original language: French
Copyright © 2023 ISSR Journals. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
The acute transformation of chronic myeloid leukemia has become a rare event since the introduction of tyrosine kinase inhibitors. Less than 3% of patients with CML transform to a megakaryoblastic leukemia. The diagnosis represents a challenge, due to the frequent association with myelofibrosis, thus requiring an osteo-medullar biopsy to confirm the diagnosis. We report the case of a megacaryoblastic blast crisis associated with myelofibrosis in a CML young female patient. A 32-year-old woman previously diagnosed with CML in chronic phase, on Tyrosine kinase inhibitors, presents with a clinical bone marrow failure. Blood counts showed pancytopenia. A peripheral blood smear revealed the presence of 30% blast cells, with a round nuclei, prominent nucleoli, and a very basophilic cytoplasm with cytoplasmic blebs. The diagnosis of a blast crisis in CML was retained. Bone marrow aspiration was practiced twice, and came back poor both times. A bone marrow biopsy practiced later confirming the diagnosis of acute leukemia associated to myelofibrosis. Immunophenotyping by flow cytometry was performed on peripheral bood, and revealed a blast population (76%) positive for CD45 (mild) and expressing the following markers CD33, CD34, CD41 and CD61, confirming the diagnosis of acute megacaryoblastic leukemia. Based on clinical presentation, bone marrow findings and flow cytometry, the diagnosis of CML with megakaryoblastic crisis associated to myelofibrosis at a 32-year-old woman was retained.
Author Keywords: Acute megakaryocytic leukemia, blast crisis, chronic myeloid leukemia.
Abstract: (french)
La transformation aigue de leucémie myéloïde chronique (LMC) est devenue un événement rare depuis l’avènement d’inhibiteurs de tyrosine kinase. Moins de 3% des cas développent une transformation en leucémie aigue mégacaryoblastique, c’est un vrai défi diagnostique vu la possibilité de l’existence d’une fibrose médullaire qui nécessite le recours à une biopsie ostéo-médullaire (BOM) pour la confirmation diagnostique. Nous rapportons dans le présent travail une transformation aigue d’une LMC en leucémie mégacaryoblastique associée à une myélofibrose chez une femme jeune de 32 ans sous inhibiteurs de la tyrosine kinase (ITK). La patiente se présente pour un tableau d’insuffisance médullaire avec à l’hémogramme une pancytopénie, et au frottis sanguin la présence de 30% de blastes de formes et de tailles hétérogènes, avec un noyau à chromatine lâche, nucléolée, et un cytoplasme très basophile parfois granuleux et vacuolé. Le diagnostic de transformation de LMC en leucémie aigüe était donc retenu. Un myélogramme a été réalisé à deux reprises et est revenu pauvre, ce qui a motivé la réalisation d’une BOM qui a appuyé le diagnostic de leucémie aigüe associée à une myélofibrose au stade MF1. L’immunophénotypage par cytométrie en flux a objectivé une population blastique de 76% (CD45 faible) exprimant les marqueurs suivants; CD33, CD34, CD41 et CD61 en faveur d’une leucémie aigue mégacaryoblastique. Au total, nous avons conclu à une transformation blastique d’une LMC en leucémie aigue mégacaryoblastique, associée à une myélofibrose chez une patiente de 32 ans sous ITK.
Author Keywords: Leucémie aigue mégacaryoblastique, leucémie myéloïde chronique, transformation aigue.
How to Cite this Article
Zineb Karouchi, Hanae Bencharef, Aya Rachidi, and Bouchra Oukkache, “Megakaryocytic blast crisis in a chronic myeloid leukemia (CML) patient: A Case report,” International Journal of Innovation and Applied Studies, vol. 39, no. 2, pp. 719–723, April 2023.
