Promyelocytic Blast Crisis of Chronic Myeloid Leukemia in a Patient Undergoing Therapy with a Tyrosine Kinase Inhibitor

Meghana Parsi; Tulin Budak-Alpdogan

doi:10.7759/cureus.7217

Promyelocytic Blast Crisis of Chronic Myeloid Leukemia in a Patient Undergoing Therapy with a Tyrosine Kinase Inhibitor

Cureus. 2020 Mar 9;12(3):e7217. doi: 10.7759/cureus.7217.

Authors

Meghana Parsi¹, Tulin Budak-Alpdogan²

Affiliations

¹ Internal Medicine, Crozer-Chester Medical Center, Upland, USA.
² Hematology/Oncology, Cooper University Hospital, Camden, USA.

Abstract

A 58-year-old male with the chronic phase of chronic myeloid leukemia (CML), treated with a tyrosine kinase inhibitor (TKI), bosutinib, since the past two years, presented with bright red bleeding per rectum and disseminated intravascular coagulation. A bone marrow biopsy reverse transcription-polymerase chain reaction revealed a promyelocytic blast crisis, with leukemic cells displaying both BCR/ABL and PML/RARα chimeric genes. Cytogenetic studies revealed translocations of both t(15;17) and t(9;22). With the initiation of all-trans retinoic acid, arsenic trioxide and gemtuzumab, the patient achieved remission, with absent PML/RARα by fluorescence in situ hybridization analysis. This case highlights the importance of long-term monitoring of patients with CML, especially those on TKIs, for the development of secondary leukemias in the future.

Keywords: acute promyelocytic leukemia; apl; blast crisis; chronic myeloid leukemia; cml; tki; tyrosine kinase inhibitor.

Publication types

Case Reports