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A Case Report, Suspected Megakaryoblastic Transformation In A Chronic Myeloid Leukemia Patient

Volume: 79  ,  Issue: 1 , June    Published Date: 04 July 2021
Publisher Name: IJRP
Views: 54  ,  Download: 24 , Pages: 103 - 108    
DOI: 10.47119/IJRP100791620212035

Authors

# Author Name
1 Dita Mernita Setyawati
2 Paulus Budiono Notopuro

Abstract

Preliminary: Chronic myeloid leukaemia (CML) is a clonal hematopoiesis stem cell disorder, characterised by reciprocal translocation between chromosomes 9 and chromosomes 22, originally named the ‘Philadelphia chromosome’(Ph). The megakaryoblastic transformation of a CML is extremely rare, consisting <3% of transformed cases. Case description: A 68-year-old male presented with a CML history since 2000 and received Imatinib therapy. The patient currently showed anemia and splenomegaly. Laboratory results showed hemoglobin 8.1 g/dL, leukocyte count 31,740/?L, platelet count 7,000/?L, Immature Platelet Fraction (IPF) 29.2%, BCR-ABL gene fusion is positive. Bone marrow examination showed CML blastic crisis phase with 45% blasts which had megakaryoblast morphology so it was concluded as a CML that underwent a transformation into megakaryoblastic. The results of bone marrow aspirate using Sysmex-XN1000 showed a very high IPF value which indicated an increased megakaryopoietic proliferative activity. Immunophenotyping examination showed blast population with CD45 dim, low side scatter, with the expression of CD34+, CD33+, CD13+ corresponding to the megakaryoblast area. Examination of the CD41 and CD61 specific megakaryoblast markers was not performed due to reagent limitations. Discussion: Clinical features, morphology, immunophenotyping and molecular findings help the identification of CML with suspected megakaryoblastic transformation. Conclusion: A CML patient has been reported with suspected megakaryoblastic transformation based on the bone marrow morphology, immunophenotyping, molecular and elevated IPF examination.

Keywords

  • chronic myeloid leukemia
  • megakaryoblastic transformation
  • BCR-ABL
  • IPF