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Chronic myeloid leukemia manifested during megakaryoblastic crisis
C D Wu1, L J Medeiros, R N Miranda
1Department of Pathology, Rhode Island Hospital and Brown University School of Medicine, Providence, USA.
Southern Medical Journal
|April 1, 1996
Summary
This study details a rare case of chronic myeloid leukemia (CML) presenting as megakaryoblastic crisis, leading to acute myelofibrosis (AMF). Chemotherapy successfully induced remission, suggesting its efficacy for CML-blast crisis and AMF.
Area of Science:
- Hematology
- Oncology
Background:
- Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm.
- Megakaryoblastic crisis is a rare, aggressive manifestation of CML.
- Acute myelofibrosis (AMF) is characterized by bone marrow fibrosis and cytopenias.
Observation:
- A 38-year-old man presented with CML features including elevated white blood cells, platelets, and peripheral blasts.
- Bone marrow biopsy revealed hypercellularity, blasts, atypical megakaryocytes, and fibrosis.
- Cytogenetic analysis identified the Philadelphia chromosome, t(9;22)(q34;q11).
Findings:
- The patient's presentation was consistent with CML in megakaryoblastic crisis.
- Subsequent development of pancytopenia and myelofibrosis indicated acute myelofibrosis.
- Blasts showed reactivity for nonspecific esterase, PAS, and factor VIII, confirming megakaryoblastic lineage.
Implications:
- CML can rarely present with megakaryoblastic crisis, potentially leading to acute myelofibrosis.
- Intensive chemotherapy, including cytosine arabinoside and etoposide, achieved remission in this case.
- This suggests that aggressive antileukemic therapy may benefit patients with CML-blast crisis or AMF.