| Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access |
| Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc |
| Journal website http://www.jocmr.org |
Case Report
Volume 8, Number 6, June 2016, pages 480-485
Extramedullary Involvement by Chronic Myelogeneous Leukemia in Five Patients With Unusual Clinicopathologic Features: A Review of the Effectiveness of Tyrosine Kinase Inhibitors
Table
| Case 1 | Case 2 | Case 3 | Case 4 | Case 5 | |
|---|---|---|---|---|---|
| *Patient 2 was treated with ARA-C and Gleevec (800 mg) for CML-BP with morphologic response and no cytogenetic response. #Patients 3 and 4 had hematologic response and partial cytogenetic response to initial treatment with imatinib (400 mg daily); however, disease progressed due to patient incompliance. | |||||
| Age at diagnosis | 21 | 25 | 36 | 28 | 27 |
| Sex | M | M | M | F | M |
| Race | W | AA | AA | AA | W |
| Prior medical history | None | None | None | HIV infection | None |
| WBC at diagnosis (103/µL) | 369 | N/A | 185 | 17 | 426 |
| Hemoglobin at diagnosis (g/dL) | 10.6 | N/A | 8.9 | 11.8 | 9.2 |
| Platelet count at diagnosis (103/µL) | 632 | N/A | 366 | 1,500 | 432 |
| PB blast (%) | 4 | N/A | 8 | < 1 | 2 |
| BM blasts (%) | < 10 | N/A | < 10 | 10% | < 10 |
| Initial diagnosis | CML-CP | CML-CP | CML-CP | CML-CP | CML-CP |
| Initial treatment | Imatinib | Imatinib | Imatinib# | Imatinib | Imatinib and dasatinib |
| Response to initial treatment | Refractory disease | Progression to CML-BP* | No cytogenetic response# | No cytogenetic response# | Progression to CML-AP |
| Second line therapy | Dasatinib | Dasatinib | None | None | Induction with ARA-C |
| Response to second line therapy | Resistant | No cytogenetic response | None | None | Complete remission |
| Duration between initial diagnosis and extramedullary involvement (months) | 10 | 56 | 6 | 60 | 27 |
| Myeloid sarcoma (MS) location | Cervical lymph node | Brain, temporal lobe | Cervical lymph node | CSF | Liver and gallbladder |
| Treatment for myeloid sarcoma | Dasatinib | Radiation and Nilotinib | 1) Imatinib: no response 2) Tasigna: improved 3) SCT | Dasatinib | SCT |
| Overall survival after diagnosis of MS (months) | 1 | 3 | 23 | 2 | 86 |
| Patient status | Expired | Expired | Expired | Expired | Alive, relapsed CML |
| Cytogenetics | t(9;22) | t(9;22) | t(9;22) | t(9;22) | t(9;22) |
| FISH | BCR/ABL 95.5% of cells | BCR/ABL 95% of cells | t(9;22) | t(9;22) | BCR/ABL 71.2% of cells |
| Break point via PCR | N/A | N/A | B2A2/B3A2(P210) | B2A2/B3A2(P210) | B2A2/B3A2(P210) |