Chronic Myeloid Leukemia: From the Classical Presentation Towards Rare Instances of Associated Blast Crises - Case Comparison and Literature Review

Le résumé fourni par la source

Chronic myeloid leukemia/CML accounts up to 20% of leukemia cases in the adult population. Even though the TKI (tyrosine kinase inhibitors) era has brought major improvements regarding evolution and prognosis, there are still certain particularities encountered in clinical practice concerning disease presentation, that can alter its evolution and the therapeutic approaches. Aim: to emphasize the diagnostic and therapeutic particularities of 3 CML cases, going from a classical form of presentation to rare instances- extremedullary lymphoid blast crisis (parasternal subcutaneous mass) and megakariocytic blast crisis. Methods: Pacient M.C., aged 25 years old, presents with hyperleukocytosis, moderate anemia and severe heptosplenomegaly; laboratory work-up showed chronic phase CML. By comparison, pacient H.I, aged 33 years old presents with similar clinical picture; laboratory work-up showed chronic phase CML. However, during clinical examination, a small parasternal mass was observed and a biopsy was performed which revealed extramedullary lymphoid blast crisis. Pacient Z.M, aged 50 years old, presents with leukocytosis, mild anemia and moderate thrombocytosis, adding to the clinical picture a severe hepatosplenomegaly. Additional laboratory work-up confirms CML with megakariocytic blast crisis. Results: different therapy protocols were applied- TKI, acute lymphoblastic leukemia protocols and acute myeloid leukemia induction regimen associated to TKIs, with favorable outcomes. Conclusions: rare CML presentation forms should not be dismissed, given the important differences brought by diverse therapeutic protocols regarding the same disease, carring great influence on prognosis and survival.

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