Skip to main content
Top

16-10-2024 | Chronic Myeloid Leukemia | Case Report Free for a limited time

Ischemic stroke as a presenting feature of promyelocytic blast phase in chronic myeloid leukemia – an uncommon presentation: a case report and literature review in the post imatinib era

Authors: Swapnil Tripathi, Vinu Balraam K. V., Amiya Ranjan Nayak, Richa Chauhan, Pradeep Kumar, Jasmita Dass, Priyanka Naranje, Mukul Aggarwal

Published in: Annals of Hematology

Login to get access

Abstract

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm (MPN characterized by reciprocal translocation in the ABL1 and BCR region of chromosomes 9 and 22 respectively. Progression to the blast phase in chronic myeloid leukemia results in a poorer prognosis. It can be of either myeloid, lymphoid or a mixed lineage. Progression to the promyelocytic blast phase is very rare, and there are no evidence-based guidelines for its management. Thrombosis in CML is not well defined. Thrombosis can be seen in patients with acute promyelocytic leukemia (APL) with venous thrombosis (VTE) being more common than arterial thrombosis. Ischemic stroke as the presenting feature of blast phase progression in CML is extremely rare. We report a case of CML who presented to us with acute ischemic stroke and subsequently was diagnosed as CML transformed to the promyelocytic blast phase. She was successfully treated with dasatinib along with all-trans retinoic acid (ATRA) and arsenic trioxide (ATO).
Literature
1.
go back to reference Kantarjian HM, Cortes JE, O’Brien S, Giles F, Garcia-Manero G, Faderl S et al (2003) Imatinib mesylate therapy in newly diagnosed patients with Philadelphia chromosome-positive chronic myelogenous leukemia: high incidence of early complete and major cytogenetic responses. Blood 101(1):97–100CrossRefPubMed Kantarjian HM, Cortes JE, O’Brien S, Giles F, Garcia-Manero G, Faderl S et al (2003) Imatinib mesylate therapy in newly diagnosed patients with Philadelphia chromosome-positive chronic myelogenous leukemia: high incidence of early complete and major cytogenetic responses. Blood 101(1):97–100CrossRefPubMed
2.
go back to reference Druker BJ, Guilhot F, O’Brien SG, Gathmann I, Kantarjian H, Gattermann N et al (2006) Five-year follow-up of patients receiving imatinib for chronic myeloid leukemia. N Engl J Med 355(23):2408–2417CrossRefPubMed Druker BJ, Guilhot F, O’Brien SG, Gathmann I, Kantarjian H, Gattermann N et al (2006) Five-year follow-up of patients receiving imatinib for chronic myeloid leukemia. N Engl J Med 355(23):2408–2417CrossRefPubMed
3.
go back to reference Jain P, Kantarjian H, Ghorab A, Sasaki K, Jabbour E, Gonzalez GN et al (2017) Prognostic factors and survival outcomes in patients with blast phase CML (CML-BP) in the tyrosine kinase inhibitor (TKI) era: cohort study of 477 patients. Cancer 123(22):4391–4402CrossRefPubMed Jain P, Kantarjian H, Ghorab A, Sasaki K, Jabbour E, Gonzalez GN et al (2017) Prognostic factors and survival outcomes in patients with blast phase CML (CML-BP) in the tyrosine kinase inhibitor (TKI) era: cohort study of 477 patients. Cancer 123(22):4391–4402CrossRefPubMed
4.
5.
go back to reference Jamieson CHM, Ailles LE, Dylla SJ, Muijtjens M, Jones C, Zehnder JL et al (2004) Granulocyte-macrophage progenitors as candidate leukemic stem cells in blast-crisis CML. N Engl J Med 351(7):657–667CrossRefPubMed Jamieson CHM, Ailles LE, Dylla SJ, Muijtjens M, Jones C, Zehnder JL et al (2004) Granulocyte-macrophage progenitors as candidate leukemic stem cells in blast-crisis CML. N Engl J Med 351(7):657–667CrossRefPubMed
6.
go back to reference Soverini S, Hochhaus A, Nicolini FE, Gruber F, Lange T, Saglio G et al (2011) BCR-ABL kinase domain mutation analysis in chronic myeloid leukemia patients treated with tyrosine kinase inhibitors: recommendations from an expert panel on behalf of European LeukemiaNet. Blood 118(5):1208–1215CrossRefPubMed Soverini S, Hochhaus A, Nicolini FE, Gruber F, Lange T, Saglio G et al (2011) BCR-ABL kinase domain mutation analysis in chronic myeloid leukemia patients treated with tyrosine kinase inhibitors: recommendations from an expert panel on behalf of European LeukemiaNet. Blood 118(5):1208–1215CrossRefPubMed
7.
go back to reference Chung HJ, Chi HS, Cho YU, Park CJ, Seo EJ, Kim KH et al (2008) Promyelocytic blast crisis of chronic myeloid leukemia during imatinib treatment. Ann Clin Lab Sci 38:283–286PubMed Chung HJ, Chi HS, Cho YU, Park CJ, Seo EJ, Kim KH et al (2008) Promyelocytic blast crisis of chronic myeloid leukemia during imatinib treatment. Ann Clin Lab Sci 38:283–286PubMed
10.
go back to reference Wolanin S, McCall RK, Pettenati MJ, Beaty MW, Insuasti-Beltran G, Powell BL et al PML-rara fusion transcripts detectable 8 months prior to promyelocytic blast crisis in chronic myeloid leukemia. Case Rep Hematol 2020 Sept 1;2020:1–8. https://doi.org/10.1155/2020/8830595 Wolanin S, McCall RK, Pettenati MJ, Beaty MW, Insuasti-Beltran G, Powell BL et al PML-rara fusion transcripts detectable 8 months prior to promyelocytic blast crisis in chronic myeloid leukemia. Case Rep Hematol 2020 Sept 1;2020:1–8. https://​doi.​org/​10.​1155/​2020/​8830595
11.
go back to reference Oku E, Imamura R, Nagata S, Takata Y, Seki R, Otsubo K et al (2007) Promyelocytic crisis of chronic myelogenous leukaemia during imatinib mesylate treatment. Acta Haematol 117:191–196CrossRefPubMed Oku E, Imamura R, Nagata S, Takata Y, Seki R, Otsubo K et al (2007) Promyelocytic crisis of chronic myelogenous leukaemia during imatinib mesylate treatment. Acta Haematol 117:191–196CrossRefPubMed
14.
go back to reference De Stefano V, Sorà F, Rossi E, Chiusolo P, Laurenti L, Fianchi L et al (2005) The risk of thrombosis in patients with acute leukemia: occurrence of thrombosis at diagnosis and during treatment. J Thromb Haemost 3(9):1985–1992CrossRefPubMed De Stefano V, Sorà F, Rossi E, Chiusolo P, Laurenti L, Fianchi L et al (2005) The risk of thrombosis in patients with acute leukemia: occurrence of thrombosis at diagnosis and during treatment. J Thromb Haemost 3(9):1985–1992CrossRefPubMed
15.
go back to reference Escudier SM, Kantarjian HM, Estey EH (1996) Thrombosis in patients with acute promyelocytic leukemia treated with and without all-trans retinoic acid. Leuk Lymphoma 20(5–6):435–439CrossRefPubMed Escudier SM, Kantarjian HM, Estey EH (1996) Thrombosis in patients with acute promyelocytic leukemia treated with and without all-trans retinoic acid. Leuk Lymphoma 20(5–6):435–439CrossRefPubMed
16.
go back to reference Stein E, McMahon B, Kwaan H, Altman JK, Frankfurt O, Tallman MS (2009) The coagulopathy of acute promyelocytic leukaemia revisited. Best Pract Res Clin Haematol 22(1):153–163CrossRefPubMed Stein E, McMahon B, Kwaan H, Altman JK, Frankfurt O, Tallman MS (2009) The coagulopathy of acute promyelocytic leukaemia revisited. Best Pract Res Clin Haematol 22(1):153–163CrossRefPubMed
Metadata
Title
Ischemic stroke as a presenting feature of promyelocytic blast phase in chronic myeloid leukemia – an uncommon presentation: a case report and literature review in the post imatinib era
Authors
Swapnil Tripathi
Vinu Balraam K. V.
Amiya Ranjan Nayak
Richa Chauhan
Pradeep Kumar
Jasmita Dass
Priyanka Naranje
Mukul Aggarwal
Publication date
16-10-2024
Publisher
Springer Berlin Heidelberg
Published in
Annals of Hematology
Print ISSN: 0939-5555
Electronic ISSN: 1432-0584
DOI
https://doi.org/10.1007/s00277-024-06044-9
SPONSORED

Recent advances in the use of CAR T-cell therapies in relapsed/refractory diffuse large B-cell lymphoma and follicular lymphoma

  • Webinar | 01-10-2024 | 12:30 (CEST)

In this webinar, Professor Martin Dreyling and an esteemed international panel of CAR T-cell therapy experts discuss the latest data on the safety, efficacy, and clinical impact of CAR T-cell therapies in the treatment of r/r DLBCL and r/r FL.

Please note, this webinar is not intended for healthcare professionals based in the US and UK.

Sponsored by:
  • Novartis Pharma AG
Chaired by: Prof. Martin Dreyling
Developed by: Springer Healthcare
Get a reminder for the on-demand version