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Case Reports
. 2024 Feb 21:14:1356311.
doi: 10.3389/fonc.2024.1356311. eCollection 2024.

Case report: BCR-ABL-positive acute lymphoblastic leukemia with bone destruction: a treatment dilemma

Shi Lijun  1 , Ma Zhongrui  2   3 , Wei Li  1 , Yu Xia  1 , Jiang Wei  1 , Pan Yaning  1
Affiliations
Case Reports

Case report: BCR-ABL-positive acute lymphoblastic leukemia with bone destruction: a treatment dilemma

Shi Lijun et al. Front Oncol. .

Abstract

Although bone destruction and hypercalcemia without acute peripheral blast BCR-ABL-positive acute lymphoblastic leukemia (ALL) have been reported in children, they are rare in adults. Herein, we describe a case of BCR-ABL positive ALL with a triploid karyotype, WT1, and CDKN2A mutations with hypercalcemia and bone destruction as the first manifestations. Complete remission (CR) was achieved by induction chemotherapy. BCR-ABL turned negative after treatment with dasatinib. However, computed tomography and whole-body bone scan showed extensive bone destruction. Additionally, bone biopsy showed leukemic infiltration. After treatment with dasatinib and VMCP, leukemia recurred with positive BCR-ABL. The T315I mutation occurred. The patient was surgically diagnosed with calculous cholecystitis and achieved CR2 by postoperative orebatinib and VP regimens. Later, the patient died due to a severe pulmonary infection. BCR-ABL-positive ALL with bone destruction is rare and difficult to control using tyrosine kinase inhibitor chemotherapy alone. Therefore, further exploration of more effective treatments is needed.

Keywords: acute lymphoblastic leukemia; hypercalcemia; osteolysis; osteolytic bone lesions; protein kinase inhibitors.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
CT scan (bone window) revealed bone destruction of Thoracic vertebrae and transverse processes (A) and ilium (B) of initial diagnosis,bone destruction of Thoracic vertebrae, transverse processes and rib (C) and ilium (D) of complete remission(CR),bone destruction of Thoracic vertebrae, transverse processes and rib (E) and ilium (F) of relapse.
Figure 2
Figure 2
Bone marrow cytology showed that primitive immature lymphocytes accounted for 83% of cells (A) of initial diagnosis,1.5% of cells (B) of after one course of induction therapy and 50.5% of cells (C) of after two sessions of consolidation therapy.
Figure 3
Figure 3
MRI (T2 imaging) revealed destruction of the thoracic vertebrae of initial diagnosis (A) and CR (B).
Figure 4
Figure 4
Bone imaging revealed multiple lesions of increased bone metabolism throughout the body of CR1 (A) and CR2 (B).
Figure 5
Figure 5
T10 vertebral bone biopsy (HE staining, 20-fold).
See this image and copyright information in PMC

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