CML Developing Three Years after Therapy Completion in a Child with Ph(−) Pre-B-ALL

Abstract

We report a girl with a history of Ph(−) pre-B-ALL and three years of disease-free survival admitting to our hospital for regular end of treatment checkup with an increased white blood cell count which in follow-up studies and molecular detection of BCR-ABL (p210) fusions gene had been diagnosed as a Ph(+) typical CML. The upcoming question in this case scenario is whether developed CML is a secondary leukemia due to previous ALL chemotherapy or just a relapse case of primary leukemia.

Chronic Myelogenous Leukemia Presenting as a Secondary Malignancy After BCR-ABL1-negative B-lymphoblastic Leukemia/Lymphoma in a Pediatric Patient

“…The only other patient described to have a Ph(−) B-ALL, and subsequently develop CML, is a 12-year-old female initially diagnosed in 2003. 7 Other, earlier case reports that purportedly described patients presenting with initial Ph(−) ALL diagnoses, followed by CML being detected at a later time, are questionable because of the limitations in ancillary techniques available for a complete workup; 8 lack of cytogenetic information at the time of ALL diagnosis; 9 questionable diagnosis of CML, due to lack of the characteristic t(9;22) translocation; 10,11 and/or the presence of a Ph chromosome at the time of ALL diagnosis, which favors an interpretation of lymphoblastic BP CML (rather than de novo ALL). 12,13…”