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Benlachgar N, Masrar A, Haidouri S, Harmouche H, Tazi Mezalek Z. Bi-lineage B- and T-lymphoid Extramedullary Blast Crisis at an Initial Presentation of Chronic Myeloid Leukemia: A Case Report and Literature Review of Extramedullary Blast Crisis. Cureus 2023; 15:e49348. [PMID: 38143593 PMCID: PMC10749144 DOI: 10.7759/cureus.49348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/26/2023] Open
Abstract
Chronic myeloid leukemia (CML) with BCR-ABL1-positive cells is a myeloproliferative neoplasm (MPN) characterized by a chromosomal translocation t(9,22)(q34.1;q11.2), which results in the formation of a Philadelphia (Ph) chromosome containing the BCR-ABL1 fusion gene. Extramedullary blast crisis (EBC) associated with bcr/abl-positive CML is a rare initial presentation. Here, we present and discuss the case of a 51-year-old man who presented with a weight loss history, cervical swelling, and left-sided abdominal pain. He had a white blood cell count of 147,910/mm3. The blood smear study revealed myelemia in 23% and 8% of blast-like cells. The bone marrow aspiration and biopsy showed a richly cellularized sample; the megakaryocytes were present; the granular neutrophil line was at 89% with blasts at 1%. The cytogenetic analysis revealed a complex karyotype with the presence of a Philadelphia chromosome t (9, 22) (q34, q11) associated with additional cytogenetic abnormalities (ACA). Molecular analysis (PCR) detected a BCR::ABL1 (p210) rearrangement. At this point, a diagnosis of CML in the chronic phase was confirmed, but a cervical lymph node biopsy analysis revealed a bi-phenotypic B/T-lymphoblastic lymphoma (LBL) and expressed at fluorescent in situ hybridization (FISH) analysis BCR::ABL1 rearrangement. These findings were consistent with the diagnosis of a bi-phenotypic B/T extramedullary blast crisis associated with CML.
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Affiliation(s)
- Naoufal Benlachgar
- Department of Clinical Hematology, Ibn Sina Hospital, University Mohamed V of Medicine, Rabat, MAR
| | - Azlarab Masrar
- Central Laboratory of Hematology, Ibn Sina Hospital, University Mohamed V of Medicine, Rabat, MAR
| | - Soukaina Haidouri
- Department of Clinical Hematology, Ibn Sina Hospital, University Mohamed V of Medicine, Rabat, MAR
| | - Hicham Harmouche
- Department of Internal Medicine, Ibn Sina Hospital, University Mohamed V of Medicine, Rabat, MAR
| | - Zoubida Tazi Mezalek
- Department of Clinical Hematology, Ibn Sina Hospital, University Mohamed V of Medicine, Rabat, MAR
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Ricard F, Cheson B, Barrington S, Trotman J, Schmid A, Brueggenwerth G, Salles G, Schwartz L, Goldmacher G, Jarecha R, Narang J, Broussais F, Galette P, Liu M, Bajpai S, Perlman E, Gillis J, Smalberg I, Terve P, Zahlmann G, Korn R. Application of the Lugano Classification for Initial Evaluation, Staging, and Response Assessment of Hodgkin and Non-Hodgkin Lymphoma: The PRoLoG Consensus Initiative (Part 1-Clinical). J Nucl Med 2023; 64:102-108. [PMID: 35835580 PMCID: PMC9841255 DOI: 10.2967/jnumed.122.264106] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 01/28/2023] Open
Abstract
Our objective was to provide consensus recommendations from a consortium of academic and industry experts in the field of lymphoma and imaging for consistent application of the Lugano classification. Methods: Consensus was obtained through a series of meetings from July 2019 until September 2021 sponsored by the Pharma Imaging Network for Therapeutics and Diagnostics (PINTaD) as part of the PINTaD Response Criteria in Lymphoma Working Group (PRoLoG) consensus initiative. Results: Consensus recommendations clarified technical considerations for PET/CT and diagnostic CT from the Lugano classification, including updating the FDG avidity of different lymphoma entities, clarifying the response nomenclature, and refining lesion classification and scoring, especially with regard to scores 4 and 5 and the X category of the 5-point scale. Combination of metabolic and anatomic responses is clarified, as well as response assessment in cases of discordant or missing evaluations. Use of clinical data in the classification, especially the requirement for bone marrow assessment, is further updated on the basis of lymphoma entities. Clarification is provided with regard to spleen and liver measurements and evaluation, as well as nodal response. Conclusion: Consensus recommendations are made to comprehensively address areas of inconsistency and ambiguity in the classification encountered during response evaluation by end users, and such guidance should be used as a companion to the 2014 Lugano classification.
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Affiliation(s)
| | - Bruce Cheson
- Lymphoma Research Foundation, New York, New York
| | - Sally Barrington
- King's College London and Guy's and St. Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom
| | - Judith Trotman
- Concord Repatriation General Hospital, University of Sydney, Concord, New South Wales, Australia
| | - Annette Schmid
- Takeda Pharmaceutical Company Ltd., Cambridge, Massachusetts
| | | | - Gilles Salles
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weil Cornell Medicine, New York, New York
| | - Larry Schwartz
- Department of Radiology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, Columbia, New York
| | | | | | - Jayant Narang
- Takeda Pharmaceutical Company Ltd., Cambridge, Massachusetts
| | | | | | - Min Liu
- Autolus Therapeutics, London, United Kingdom
| | | | - Eric Perlman
- Perlman Advisory Group LLC, Boynton Beach, Florida
| | | | - Ira Smalberg
- Saint John's Cancer Institute and Tower Imaging Medical Group, Sherman Oaks, California
| | | | - Gudrun Zahlmann
- Quantitative Imaging Biomarkers Alliance, Radiological Society of North America, Oak Brook, Illinois; and
| | - Ron Korn
- TGEN/City of Hope and Imaging Endpoints Core Lab, Scottsdale, Arizona
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