title: Chronic myelogenous leukemia in chronic phase transforming into acute leukemia under treatment with dasatinib 4 months after diagnosis.
abstract: We report a 64-year-old woman morphologically diagnosed with chronic myelogenous leukemia in the chronic phase. Despite having achieved a complete hematological response following treatment with dasatinib, she developed lymphoblastic crisis 4 months later. Blastic cells were in a CD45-negative and SSC-low fraction, and positive for CD10, CD19, CD34, and HLA-DR expression and rearrangement in the immunoglobulin heavy chain gene. Chemotherapy using the HyperCVAD/MA regimen led to a complete cytogenetic response, and after cord blood transplantation, she obtained a complete molecular remission. However, the crisis recurred 6 months later. Another salvage therapy using L-AdVP regimen followed by nilotinib led to a complete molecular remission. Retrospective analyses using flow cytometry and polymerase chain reaction revealed a minimal blastic crisis clone present in the initial marrow in chronic phase. This case is informative as it suggests that sudden blastic crisis may occur from an undetectable blastic clone present at initial diagnosis and that leukemic stem cells may survive cytotoxic chemotherapy that eliminates most of the blastic cells.
authors.affiliation: Department of Hematology and Oncology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-Gun, Tochigi, 321-0293, Japan.
authors.forename: Yukitsugu
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Department of Hematology and Oncology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-Gun, Tochigi, 321-0293, Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Tokita
authors.affiliation: Department of Hematology and Oncology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-Gun, Tochigi, 321-0293, Japan.
authors.forename: Fusako
authors.initials: F
authors.lastname: Nagasawa
authors.affiliation: Department of Hematology and Oncology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-Gun, Tochigi, 321-0293, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Takahashi
authors.affiliation: Department of Hematology and Oncology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-Gun, Tochigi, 321-0293, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Department of Hematology and Oncology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-Gun, Tochigi, 321-0293, Japan.
authors.forename: Ko
authors.initials: K
authors.lastname: Sasaki
authors.affiliation: Department of Hematology and Oncology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-Gun, Tochigi, 321-0293, Japan.
authors.forename: Motoshi
authors.initials: M
authors.lastname: Ichikawa
authors.affiliation: Department of Hematology and Oncology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-Gun, Tochigi, 321-0293, Japan. mitanik@mx.dokkyomed.ac.jp.
authors.forename: Kinuko
authors.initials: K
authors.lastname: Mitani
mesh_terms: D000210:Acute-Phase Reaction; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001215:Asparaginase / Q000008:administration & dosage; D001752:Blast Crisis; D003520:Cyclophosphamide / Q000008:administration & dosage; D000069439:Dasatinib / Q000627:therapeutic use*; D003907:Dexamethasone / Q000008:administration & dosage; D018450:Disease Progression; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005312:Fetal Blood / Q000637:transplantation; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D013997:Time Factors; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D001215:Asparaginase; D000069439:Dasatinib
keywords: Chronic myelogenous leukemia; Dasatinib; Flow cytometry; Gene rearrangement; Sudden blastic crisis