ANNOUNCEMENTS
Submission for the Journal in 2024 is open now More
Acceptance of Application Forms for participation in International Competition
ICMHDS-2024 is has already closed More
Acceptance of Application Forms for participation in International Academic Conferences 
CIES-2024 open now More
Blast Crisis in Chronic Myeloid Leukemia: An Immunophenotypic Analysis
Singh Ak.1, Singh An.1, Kanaujia S.1, Kushwaha R.1, Singh U. S.1
 
 
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

 

 
 
  
 
 
 
 
  
 
 
  
 
  
 
Information about the authors:

Singh Akanksha (Corresponding Author) – https://orcid.org/0000-0001-5398-6203; This email address is being protected from spambots. You need JavaScript enabled to view it., MD, Senior Resident, Department of Pathology, King George’s Medical University, Lucknow, India.

Singh Anuraghttps://orcid.org/0000-0002-1979-8847; MD, Senior Resident, Department of Pathology, King George’s Medical University, Lucknow, India.

Kanaujia Swetahttps://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 Shankarhttps://orcid.org/0000-0002-9748-9484; MD, Professor, Head of the Department of Pathology, King George’s Medical University, Lucknow, India.

 
 
 
Cite this article as:

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.pdf

Vancouver


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

  2018 – 2024 International Journal of Science Annals
DOI: https://doi.org/10.26697/ijsa