Osteolytic lesion in chronic myelogenous leukaemia

Area of Science:

• Hematology
• Oncology
• Pathology

Background:

• Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by the Philadelphia chromosome.
• While CML typically progresses through chronic, accelerated, and blastic phases, extramedullary involvement can occur.
• Bone marrow involvement is common, but destructive bone lesions are an infrequent manifestation.

Observation:

• A destructive femur lesion was identified in one patient within a cohort of 103 CML patients.
• Touch preparations from the bone biopsy revealed numerous myeloblasts.
• At the time of bone lesion diagnosis, peripheral blood and bone marrow differentials were consistent with the chronic phase of CML.

Findings:

• The patient later developed a blastic crisis 5 months after the bone lesion was identified.
• Radiotherapy provided pain palliation but did not alter the disease's progression to blastic transformation.
• The blastic crisis was refractory to treatment, leading to the patient's death 3 years after CML diagnosis.

Implications:

• Destructive bone lesions in CML patients may represent an early sign of blastic transformation.
• This case underscores the importance of investigating bone pain and lesions in CML patients.
• Early recognition of such manifestations could potentially inform treatment strategies, although blastic crisis remains challenging to manage.