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Case Reports
. 2018 Nov;97(44):e12949.
doi: 10.1097/MD.0000000000012949.

Primary Philadelphia chromosome positive acute myeloid leukemia: A case report

Xiaoyan Shao  1 , Dangui Chen  2 , Peipei Xu  1 , Miaoxin Peng  1 , Chaoyang Guan  1 , Pinhao Xie  1 , Cuiying Yuan  1 , Bing Chen  2
Affiliations
Case Reports

Primary Philadelphia chromosome positive acute myeloid leukemia: A case report

Xiaoyan Shao et al. Medicine (Baltimore). 2018 Nov.

Abstract

Rationale: Philadelphia chromosome positive acute myeloid leukemia (Ph+ AML) is a rare subtype of AML that is now included as a provisional entity in the 2016 revised WHO classification of myeloid malignancies. However, a clear distinction between de novo Ph+ AML and chronic myeloid leukemia blast crisis is challenging. It is still a matter of debate whether Ph+ AML patients should be treated with chemotherapy or tyrosine kinase inhibitors as first-line therapy.

Patient concerns: We reported here a case of a 46-year-old man who was diagnosed as Ph+ AML. This diagnosis was confirmed by bone marrow pathology and karyotype analysis of 46, XY, t (9; 22). Further examination, molecular genetic analysis showed BCR/ABL1 (p190) without ABL1 kinase domain mutations, and direct evidence demonstrated in AML by flow cytometry.

Diagnosis: The diagnosis of Ph+ AML was made on May 2016 according to morphology, immunology, cytogenetic, and molecular criteria, and multiple organ failure was also diagnosed.

Interventions: The patient was treated with dasatinib as the only medication after experiencing multiple organ failure. Then, he received 2 cycles of chemotherapy with IA (idarubicin 8 mg/m, day 1-3; cytarabine 100 mg/m, day 1-7) in August, 2016.

Outcomes: The patient finally achieved a complete molecular remission.

Lessons: This case study suggests that dasatinib can be a safe and effective treatment for Ph+ AML patients with poor physical condition.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
The patient's bone marrow pathology. A, The patient's bone marrow smear in May 2016 (Wright stain, 10 × 10). B, The arrow point to primitive monocytes showed in bone marrow smear in May 2016 (Wright stain, 10 × 100). C, The arrow point to primitive monocytes in bone marrow smear was negative with POX in May 2016 (peroxidase stain POX, 10 × 100). D, The patient achieved complete remission after treatment with dasatinib for 2 months (Wright stain, 10 × 100).
Figure 2
Figure 2
The patient's molecular analysis. The patient's molecular analysis revealed BCR/ABL1 positive without ABL1 mutations in May 2016.
Figure 3
Figure 3
The patient's flow cytometry analysis. Leukemia cells expressed CD13, CD33, CD34, CD11b, CD19, HLA-DR, and CD38, whereas MPO was detected negative.
See this image and copyright information in PMC

References

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