Monoblastic transformation in chronic myelogenous leukemia: presentation with massive hepatic involvement

Area of Science:

• Hematology
• Oncology
• Hepatology

Background:

• Chronic myelogenous leukemia (CML) is a myeloproliferative neoplasm.
• Monoblastic transformation is a rare but aggressive complication of CML.
• Acute liver failure can be a presenting or complicating feature of blastic transformation.

Observation:

• A 26-year-old male with CML presented with acute, fulminant hepatic failure.
• Massive blastic infiltration of the liver was identified as the cause of hepatic failure.
• The patient's condition showed a dramatic response to radiation therapy.

Findings:

• Morphological and cytochemical studies confirmed the monocytic origin of the leukemic blasts.
• Cytogenetic analysis revealed a Philadelphia chromosome-positive karyotype in the leukemic cells.
• Evidence of clonal evolution with multiple karyotypes was observed, indicating disease progression.

Implications:

• This case highlights the potential for monoblastic transformation in CML presenting as liver failure.
• Radiation therapy can be an effective treatment modality for hepatic failure secondary to CML blastic transformation.
• Understanding the cytogenetic evolution is crucial for managing advanced CML.
• The findings contribute to the knowledge of rare CML complications and treatment responses.