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Case Reports
. 2019 Aug 17:12:100184.
doi: 10.1016/j.lrr.2019.100184. eCollection 2019.

T315I-mutated myeloid sarcoma

Yumeng Zhang  1 , David M Swoboda  2 , Aditya Grover  1 , Lisa Nodzon  2 , Ling Zhang  2 , Javier Pinilla-Ibarz  2
Affiliations
Case Reports

T315I-mutated myeloid sarcoma

Yumeng Zhang et al. Leuk Res Rep. .

Erratum in

Abstract

Myeloid Sarcoma (MS) is diagnosed by an extramedullary proliferation of immature granulocytic cells. Its association with chronic myeloid leukemia (CML) is rare. CML is characterized by BCR-ABL1 gene rearrangement and therapies with tyrosine kinase inhibitors (TKI) are very effective. However, TKI resistance may occur secondary to the development of ABL1 mutations. T315I is a common mutation that accounts for ∼20% clinical resistance to TKIs. We report the first case of a patient with T315I mutated myeloid sarcoma that occurred after complete cytogenetic response with dasatinib of a chronic phase CML. The patient was successfully treated with induction chemotherapy and ponatinib.

Keywords: Chronic myelogenous leukemia; Myeloid sarcoma; T315I mutation.

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Figures

Fig 1
Fig. 1
A) MRI of large hyperintense mass in proximal femur with osseous involvement and satellite metastatic nodules. B) Whole Body PET/CT showed a large destructive proximal right femur lesion with avid uptake with SUV maximum 13.3.
Fig 2
Fig. 2
A. Bone marrow aspirate shows adequate cellularity with complete myeloid maturation and essentially normal myeloid to erythroid ratio, consistent with hematologic remission, post treatment for chronic myeloid leukemia (Wright-Giemsa, x1000) and B. the bone marrow core shows normal trilineage hematopoiesis with adequate M:E ratio (H&E, x600. Core biopsy of femur. C) showed immature precursors with oval to irregular nuclei, fine chromatin, eosinophilic cytoplasm and inconspicuous nucleoli associated with fibrosis and scattered eosinophils (H&E, x100). D) immunohistochemical stain highlights the immature precursors/blasts to be CD34 positive (immunoperoxidase, x100).
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