title: Successful treatment of lymphoid blastic crisis in chronic myelogenous leukemia with the additional bcr/abl transcript using imatinib-combined chemotherapy and high-dose chemotherapy with allogeneic bone marrow stem cell transplantation.
abstract: Chronic myelogenous leukemia (CML) is a myeloproliferative disorder characterized by the presence of the Philadelphia chromosome. Although the major BCR/ABL transcript is present in majority of CML patients, the minor BCR/ABL transcript is rarely reported as an additional chromosomal abnormality related to the progression of CML. We describe the case of a 37-year-old woman who had CML and pain in the extremities. She was diagnosed with lymphoid blast crisis of CML on the basis of the following findings: presence of promyelocytes, myelocytes, and metamyelocytes in peripheral blood smear; detection of major and minor BCR/ABL transcripts by polymerase chain reaction analysis; proliferation of lymphoblastic cells with abnormal B-cell phenotype; and aberrant expression of myeloid antigens in the bone marrow. The patient underwent one course of idarubicin and cytosine arabinose therapy combined with imatinib followed by daunorubicin/cyclophosphamide plus vincristine and prednisone/L: -asparaginase (DNR/COP/L: -ASP) therapy, high-dose cytosine arabinose, and CHOP therapy (cyclophosphamide, doxorubicin, vincristine, and prednisolone). Subsequently, the patient underwent high-dose chemotherapy (total body irradiation and cyclophosphamide) followed by allogeneic bone marrow stem cell transplantation from a human leukocyte antigen (HLA)-matched unrelated donor. After these treatments, the patient was disease-free for 19 months. Our case suggests that these treatments may be feasible, safe, and effective for the treatment of patients with blast crisis CML expressing the minor BCR/ABL transcript.
authors: Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan. kawanoriaki@yahoo.co.jp
authors: Noriaki
authors: N
authors: Kawano
authors: Shinya
authors: S
authors: Okuda
authors: Shuro
authors: S
authors: Yoshida
authors: Hiroko
authors: H
authors: Kugimiya
authors: Masaki
authors: M
authors: Ito
authors: Nagako
authors: N
authors: Horikawa
authors: Nobuaki
authors: N
authors: Chosa
authors: Tomoko
authors: T
authors: Hisakata
authors: Tomoko
authors: T
authors: Fukudome
authors: Ryoko
authors: R
authors: Sakurai
authors: Kiyoshi
authors: K
authors: Yamashita
authors: Akira
authors: A
authors: Ueda
authors: Yoshinobu
authors: Y
authors: Kanda
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001549:Benzamides; D001752:Blast Crisis / Q000188:drug therapy / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D016044:Fusion Proteins, bcr-abl / Q000235:genetics; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000068877:Imatinib Mesylate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D010677:Philadelphia Chromosome; D010879:Piperazines / Q000008:administration & dosage; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000209:etiology / Q000473:pathology* / Q000628:therapy*; D011743:Pyrimidines / Q000008:administration & dosage; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate; D016044:Fusion Proteins, bcr-abl