Chronic myelogenous leukemia in chronic phase transforming into acute leukemia under treatment with dasatinib 4 months after diagnosis.
Chronic myelogenous leukemia in chronic phase transforming into acute leukemia under treatment with dasatinib 4 months after diagnosis.
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慢性粒细胞白血病在诊断后4个月接受达沙替尼治疗后转变成急性白血病。
DOI：
10.1007/s12185-015-1909-7
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Mitani K.
中科院分区：
文献类型：
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作者：
Nakamura Y;Tokita T;Nagasawa F;Takahashi W;Nakamura Y;Sasaki K;Ichikawa M;Mitani K.
我们报告一位64岁女性，经形态学诊断为慢性粒细胞白血病慢性期。尽管在达沙替尼治疗后达到了完全血液学缓解，但4个月后她发生了淋巴母细胞危象。母细胞为CD 45阴性和SSC低分数，CD 10、CD 19、CD 34和HLA-DR表达阳性，免疫球蛋白重链基因重排阳性。使用HyperCVAD/MA方案的化疗导致了完全的细胞遗传学缓解，在脐带血移植后，她获得了完全的分子缓解。然而，6个月后，危机再次出现。另一种挽救治疗使用L-AdVP方案，随后尼洛替尼导致完全分子缓解。使用流式细胞术和聚合酶链反应的回顾性分析显示，在慢性期的初始骨髓中存在一个最小的原始细胞危象克隆。该病例提供了大量信息，因为它表明在初次诊断时无法检测到的母细胞克隆可能会发生突然的母细胞危象，白血病干细胞可能在消除大部分母细胞的细胞毒性化疗中存活。
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.