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Case Study (2)- Chronic Myeloid Leukemia (CML)

Case Study (2)- Chronic Myeloid Leukemia (CML) 


37-year-old female. History of fibrocystic breast disease. Seen for routine workup before breast biopsy. 

Physical Examination:

Moderate splenomegaly.
No other organomegaly

Laboratory Investigations:

1. CBC: (with microscopic differential)

RBC 4.27 x 1012/L

HGB 13.5 g/dL

HCT 41.2 %

MCV 96.3 fL

MCH 31.3 pg

MCHC 32.5 g/dL

WBC 133.6 x 109/L

N seg 56 %

N band 15 %

N metamyelocytes 13 %

N myelocytes 4 %

N promyelocytes 3 %

L 3 %

M 4 %

E 1 %

Blasts 1 %

PLT 416 x109/L

Morphologic Alterations

Results of the blood smear exam were:

RBC morphology: Normocytic, normochromic

WBC morphology: Mature stages and precursors all within normal morphologic limits.

PLT morphology: Within normal limits

2. Bone marrow examination:

Aspirate differential (1000 cells):

Erythroblasts 9.9%

Myeloblasts 1.1 N

promyelocytes 1.4 N and precursors 71.7L 2.0M 2.8E and precursors 2.2 B and precursors 8.9

Sections: Markedly hypercellular with increased megakaryocytes.

3. Cytochemistry:

Leukocyte alkaline phosphatase [LAP] score: 3 (RI 64-176)

4. Cytogenetics:

46, XX, t (9;22) (q34; q11) (Philadelphia chromosome) seen in all marrow cells analyzed.



Chronic Myeloid Leukemia (CML)

Clinical Course

Following the standard preparatory regimen, the patient received an allogeneic bone marrow transplant. The donor was her HLA-matched brother.

Her post-transplant course went well, and 28 days later, her hemoglobin was 11.9 g/dL, WBC 2.0 x 109/L, and PLT 84 x 109/L. Her marrow showed evidence of good engraftment in all three cell lines.

This patient continues to be followed in Hematology Clinic. At last visit, ten years post-transplant, she was doing well and had no evidence of recurrent of the disease. Molecular diagnostic test performed at that time were negative for BCR-abl transcripts.