Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May;100(3):345-351.
doi: 10.1002/cyto.b.21958. Epub 2020 Oct 8.

Sudden blast phase in pediatric chronic myeloid leukemia-chronic phase with abnormal lymphoid blasts detected by flow cytometry at diagnosis: Can it be considered a warning sign?

Kalasekhar Vijayasekharan  1   2   3 , Gaurav Chatterjee  2   4 , Subramaniam Ramanathan  1   2 , Gaurav Narula  1   2 , Prashant Tembhare  2   4 , Papagudi G Subramanian  2   4 , Nikhil Patkar  2   4 , Sumeet Gujral  2   4 , Dhanlaxmi Shetty  2   4 , Shripad Banavali  1   2
Affiliations
Free article

Sudden blast phase in pediatric chronic myeloid leukemia-chronic phase with abnormal lymphoid blasts detected by flow cytometry at diagnosis: Can it be considered a warning sign?

Kalasekhar Vijayasekharan et al. Cytometry B Clin Cytom. 2021 May.
Free article

Abstract

Background: Inconclusive knowledge persists regarding the course of chronic myeloid leukemia-chronic phase (CML-CP) patients with detectable abnormal blasts by flow-cytometry at diagnosis. The 2016 WHO classification is not specific regarding sub-classification of CML with <10% abnormal B-lymphoid blasts (ABLB), and suggests these patients often show rapid progression. We report the clinical course of pediatric CML-CP patients who had detectable abnormal blasts by flow-cytometry at baseline.

Methods: Retrospective audit of all pediatric CML patients between January 2013 and December 2017 were included. Their clinical presentation, demographic profile, and treatment outcomes were extracted from electronic medical records. Some of these patients got flow-cytometry done by default, though it was not a routine part of diagnostic CML marrow studies.

Results: Amongst 65 pediatric CML patients, flow-cytometry at initial diagnosis was available in 15 (CP-12; AP-3). Of the 12 CML-CP patients, 10 (83%) had abnormal flow-cytometric findings-5 (50%) with mixed lineage blasts (4-B/Myeloid, 1-B/T/Myeloid), and myeloid lineage blasts in the remaining 5 (50%). At a median follow-up of 26 months (range: 9-34 months), 3/5 patients with ABLB at diagnosis progressed to frank blast crisis (2 B-cell; 1 Mixed lineage). None among the five patients with diagnostic myeloid-alone aberrant blasts progressed to blast crisis. Imatinib resistant mutation was also found in 3/5 (60%) CML-CP patients with these ABLB at baseline.

Conclusions: Although a retrospective study with limited sample size, presence of ABLB detected on flow-cytometry in CML-CP patients, had a noticeable early conversion to CML-BC in our cohort. Incorporation of flow-cytometry in diagnostic work-up can provide useful insight regarding the behavior of pediatric CML-CP patients and guide therapy.

Keywords: abnormal lymphoblasts; blast crisis; chronic myeloid leukemia; flow cytometry.

PubMed Disclaimer

References

REFERENCES

    1. Andolina, J. R., Neudorf, S. M., & Corey, S. J. (2012). How I treat childhood CML. Blood, 119(8), 1821-1830. https://doi.org/10.1182/blood-2011-10-380774
    1. Arber, D. A., Orazi, A., Hasserjian, R., Thiele, J., Borowitz, M. J., le Beau, M. M., … Vardiman, J. W. (2016). The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood, 127(20), 2391-2405. https://doi.org/10.1182/blood-2016-03-643544
    1. Derderian, P. M., Kantarjian, H. M., Talpaz, M., O'Brien, S., Cork, A., Estey, E., … Keating, M. (1993). Chronic myelogenous leukemia in the lymphoid blastic phase: Characteristics, treatment response, and prognosis. The American Journal of Medicine, 94(1), 69-74.
    1. El Rassi, F., Bergsagel, J. D., Arellano, M., Gaddh, M., Jillella, A., Kota, V., … Khoury, H. J. (2015). Predicting early blast transformation in chronic-phase chronic myeloid leukemia: Is immunophenotyping the missing link? Cancer, 121(6), 872-875. https://doi.org/10.1002/cncr.29142
    1. Ganta, R. R., Nasaka, S., Linga, V. G., Gundeti, S., Maddali, L. S., & Digumarti, R. R. (2017). Effectiveness of three prognostic scoring systems in predicting the response and outcome in pediatric chronic myeloid leukemia chronic phase on frontline Imatinib. Indian Journal of Medical and Paediatric Oncology, 38(3), 282-286. https://doi.org/10.4103/ijmpo.ijmpo_104_16

LinkOut - more resources