1 King George’s Medical University, Lucknow, India |
Abstract
Background and Aim of Study: There are two different phases of untreated chronic myeloid leukemia – chronic phase, and blast crisis – according to the World Health Organization classification of Hematolymphoid tumors. The blast cells in the chronic myeloid leukemia blast crisis can express myeloid, lymphoid, bi-phenotypic, monocytic, megakaryocytic, and erythroid phenotypes. The immunophenotype of blast population determines how chronic myeloid leukemia – blast crisis patients respond to treatment, hence flowcytometric examination is required.
The aim of the study: to assess immunophenotyping outcomes of flowcytometry performed on the chronic myeloid leukemia – blast crisis.
Material and Methods: A five-year retrospective descriptive analysis was carried out in Pathology Department at King George’s Medical University Lucknow, India (2017-2021). The patient’s peripheral blood and bone marrow aspirate samples were analyzed. Clinical, hematological, and immunophenotypic data were retrieved. The flow cytometry samples were prepared using the standardized “lyse-stain-wash” method.
Results: A total of 43 cases of chronic myeloid leukemia – blast crisis were retrieved from the departmental archive in 5 years. The mean age of study population was 39.62±14.86 years. There were 24 males and 19 females. 27 patients were diagnosed with myeloid blast crisis, 14 cases of B-lymphoid blast crisis and 2 cases of mixed phenotypic acute leukemia.
Conclusions: Identification of the blast lineage of patients with chronic myeloid leukemia – blast crisis is crucial since the existence of atypical blast phenotypes influences the disease treatment and prognosis.
Keywords
immunophenotyping, flowcytometry, chronic myeloid leukemia, lymphoid blast, myeloid blast, mixed phenotypic acute leukemia
References
Arber, D. A., Orazi, A., Hasserjian, R., Thiele, J., Borowitz, M. J., Le Beau, M. M., Bloomfield, C. D., Cazzola, M., & Vardiman, J. W. (2016). The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood, 127(20), 2391-2405. https://doi.org/10.1182/blood-2016-03-643544
Asif, M., Hussain, A., & Rasool, M. (2016). A rare case of a three way complex variant positive Philadelphia translocation involving chromosome (9; 11; 22 (q34; p15; q11) in chronic myeloid leukemia: A case report. Oncology Letters, 12(3), 1986-1988. https://doi.org/10.3892/ol.2016.4821
Assi, R., & Short, N. (2020). Blast crisis of chronic myeloid leukemia (CML). In Nates, J., & Price, K. (Eds.), Oncologic Critical Care (pp. 1135-1145). Springer, Cham. https://doi.org/10.1007/978-3-319-74588-6_93
Barge, L., Cleary, R., Morris, K., & Simleit, E. (2022). Incidence and immunophenotype of abnormal lymphoblast populations at diagnosis of chronic myeloid leukaemia in chronic phase. Journal of Hematopathology, 15, 51–56. https://doi.org/10.1007/s12308-022-00487-7
Bonifacio, M., Stagno, F., Scaffidi, L., Krampera, M., & Di Raimondo, F. (2019). Management of chronic myeloid leukemia in advanced phase. Frontiers in Oncology, 9, 1132. https://doi.org/10.3389/fonc.2019.01132
Chen, Z., Hu, S., Wang, S. A., Konopleva, M., Tang, Z., Xu, J., Li, Sh., Toruner, G., Thakral, B., Medeiros, L. J., & Tang, G. (2020). Chronic myeloid leukemia presenting in lymphoblastic crisis, a differential diagnosis with Philadelphia-positive B-lymphoblastic leukemia. Leukemia & Lymphoma, 61(12), 2831-2838. https://doi.org/10.1080/10428194.2020.1795160
Esfahani, M. K., Morris, E. L., Dutcher, J. P., & Wiernik, P. H. (2006). Blastic phase of chronic myelogenous leukemia. Current Treatment Options in Oncology, 7(3), 189-199. https://doi.org/10.1007/s11864-006-0012-y
Hegde, V., Singh, S., Sinha, P., Dhar, L., Aggarwal, S., Bhadoria, D. P., & Daga, M. K. (2020). Flow cytometry in chronic myelogenous leukemia blast crisis. Iranian Journal of Blood and Cancer, 12(3), 80-83. https://ijbc.ir/article-1-966-fa.pdf
Hehlmann, R., Saußele, S., Voskanyan, A., & Silver, R. T. (2016). Management of CML-blast crisis. Best Practice & Research Clinical Haematology, 29(3), 295-307. https://doi.org/10.1016/j.beha.2016.10.005
Hodkinson, K. E., Bouwer, N., & Vaughan, J. (2022). South African study of blast phase chronic myeloid leukaemia: A poor prognostic outlook. African Journal of Laboratory Medicine, 11(1), 1578. https://doi.org/10.4102/ajlm.v11i1.1578
Ivanov, S., Sharma, P., Jobanputra, Y., & Zhang, Y. (2020). Transformation of chronic myeloid leukemia to acute biphenotypic leukemia. Journal of Medical Cases, 11(8), 239-242. https://doi.org/10.14740/jmc3511
Khemka, R., Gupta, M., & Jena, N. K. (2019). CML with megakaryocytic blast crisis: Report of 3 cases. Pathology & Oncology Research, 25(3), 1253-1258. https://doi.org/10.1007/s12253-018-0484-7
Khoury, J. D., Solary, E., Abla, O., Akkari, Y., Alaggio, R., Apperley, J. F., Bejar, R., Berti, E., Busque, L., Chan, J. K. C., Chen, W., Chen, X., Chng, W.-J., Choi, J. K., Colmenero, I., Coupland, S. E., Cross, N. C. P., De Jong, D., Elghetany, M. T. … Hochhaus, A. (2022). The 5th edition of the World Health Organization classification of haematolymphoid tumours: Myeloid and histiocytic/dendritic neoplasms. Leukemia, 36, 1703-1719. https://doi.org/10.1038/s41375-022-01613-1
Narang, V., Sachdeva, M. U. S., Bose, P., Varma, N., Malhotra, P. & Varma, S. (2016). Immunophenotyping in chronic myeloid leukemia blast crisis: Looking beyond morphology. Journal of Postgraduate Medicine, Education and Research, 50(4), 181-184. https://doi.org/10.5005/jp-journals-10028-1215
Pandey, M. K., & Pal, S. (2021). Evaluation of chronic myelogenous leukemia (CML) as the chronic phase of disease using machine learning techniques. International Journal of Mechanical Engineering, 6, 198-206. https://kalaharijournals.com/resources/SP-Vol.6_32.pdf
Rahnemoon, A. R. (2022). Immunophenotyping investigation in acute and chronic leukemias as a gold standard test. Cancer Research and Cellular Therapeutics, 6(1). https://doi.org/10.31579/2640-1053/106
Rajkumar, N. N., Raghavendra, H. V., Raghu, V. C., & Chinnagiriyappa, L. K. (2016). Flow immunophenotyping features of crisis phase of chronic myeloid leukemia in childhood: Do we really care? International Journal of Medical Research and Review, 4(3), 463-469. https://doi.org/10.17511/ijmrr.2016.i03.31
Shi, Y., Rand, A. J., Crow, J. H., Moore, J. O., & Lagoo, A. S. (2015). Blast phase in chronic myelogenous leukemia is skewed toward unusual blast types in patients treated with tyrosine kinase inhibitors: A comparative study of 67 cases. American Journal of Clinical Pathology, 143(1), 105-119. https://doi.org/10.1309/AJCPWEX5YY4PHSCN
Tembhare, P. R., Subramanian PG, P. G., Ghogale, S., Chatterjee, G., Patkar, N. V., Gupta, A., Shukla, R., Badrinath, Y., Deshpande, N., Narula, G., Rodrigues, P., Girase, K., Dhaliwal, D., Prasad, M., Shetty, D., Banavali, S., & Gujral, S. (2020). A high‐sensitivity 10‐color flow cytometric minimal residual disease assay in B‐lymphoblastic leukemia/lymphoma can easily achieve the sensitivity of 2‐in‐106 and is superior to standard minimal residual disease assay: A study of 622 patients. Cytometry Part B: Clinical Cytometry, 98(1), 57-67. https://doi.org/10.1002/cyto.b.21831
Wang, L., Li, L., Chen, R., Huang, X., & Ye, X. (2021). Understanding and monitoring chronic myeloid leukemia blast crisis: How to better manage patients. Cancer Management and Research, 13, 4987-5000. https://doi.org/10.2147/CMAR.S314343
Yohannan, B., & George, B. (2022). B-Lymphoid blast phase – chronic myeloid leukemia: Current therapeutics. International Journal of Molecular Sciences, 23(19), 11836. https://doi.org/10.3390/ijms231911836
Singh Akanksha (Corresponding Author) – https://orcid.org/0000-0001-5398-6203;
Singh Anurag – https://orcid.org/0000-0002-1979-8847; MD, Senior Resident, Department of Pathology, King George’s Medical University, Lucknow, India.
Kanaujia Sweta – https://orcid.org/0000-0003-3369-1664; MD, Resident, Department of Pathology, King George’s Medical University, Lucknow, India.
Kushwaha Rashmi – https://orcid.org/0000-0002-0581-2177; MD, Professor, Department of Pathology, King George’s Medical University, Lucknow, India.
Singh Uma Shankar – https://orcid.org/0000-0002-9748-9484; MD, Professor, Head of the Department of Pathology, King George’s Medical University, Lucknow, India.
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APA
Singh, Ak., Singh, An., Kanaujia, S., Kushwaha, R., & Singh, U. S. (2022). Blast crisis in chronic myeloid leukemia: An immunophenotypic analysis. International Journal of Science Annals, 5(1-2), 31–37. https://doi.org/10.26697/ijsa.2022.1-2.3
Harvard
Singh, Ak., Singh, An., Kanaujia, S., Kushwaha, R., & Singh, U. S.. 2022. "Blast crisis in chronic myeloid leukemia: An immunophenotypic analysis". International Journal of Science Annals, [online] 5(1-2), pp. 31-37. viewed 25 December 2022, https://culturehealth.org/ijsa_archive/ijsa.2022.1-2.3.pdfVancouver
Singh Ak., Singh An., Kanaujia S., Kushwaha R., & Singh U. S. Blast crisis in chronic myeloid leukemia: An immunophenotypic analysis. International Journal of Science Annals [Internet]. 2022 [cited 25 December 2022]; 5(1-2): 31-37. Available from: https://culturehealth.org/ijsa_archive/ijsa.2022.1-2.3.pdf https://doi.org/10.26697/ijsa.2022.1-2.3