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

Kalasekhar, VS (2020) Sudden blast phase in pediatric chronic myeloid leukemiachronic phase with abnormal lymphoid blasts detected by flow cytometry at diagnosis: Can it be considered a warning sign? Cytometry Part B - Clinical Cytometry, 100 (3). pp. 345-351. ISSN 1552-4949

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Abstract

Background: Inconclusive knowledge persists regarding the course of chronic myeloid leukemia-chronic phase (CML-CP) patients with detectable abnormal blasts by flowcytometry at diagnosis. The 2016 WHO classification is not specific regarding subclassification 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

Item Type: Article
Uncontrolled Keywords: Abnormal lymphoblasts; Blast crisis,; Chronic myeloid leukemia; Flow cytometry
Subjects: Medicine > KMC Manipal > Medical Oncology
Depositing User: KMC Library
Date Deposited: 29 Sep 2021 04:52
Last Modified: 29 Sep 2021 04:52
URI: http://eprints.manipal.edu/id/eprint/157456

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