Morphological and Immunological Pattern of Blastic Transformation in Chronic Myeloid Leukemia in Saudi Arabia: Study of 90 Transformations Among 248 Patients

Abstract

We examined the pattern of blastic transformation in 90 of 248 patients (36%) with chronic myeloid leukemia who were seen at the King Faisal Specialist Hospital and Research Centre between 1975 and1988. The mean and median ages of all patients were 38.2 and 36.0 years, respectively. Four of the 90 transformants (4.4%) presented in blastic transformation, and 86 cases (95.5%) evolved from a well-defined chronic phase. Twenty-nine (32.2%) of the patients underwent lymphoid blastic transformation, while 28 (31.1%) were myeloid, seven (7.8%) were myelomonocytic, four (4.4%) were monocytic or erythroblastic, six (6.7%) were megakaryoblastic, ten (11.1%) were of mixed lineage, and two (2.2%) were unclassifiable. The lymphoid blast cells were uniformly common acute lymphocytic leukemia (i.e., Ia and CD10 positive), whereas the myeloid transformations were predominantly Ia negative. Mixed phenotype blasts were also predominantly Ia positive (i.e., 8 of 10), with varying positivity for CD10 and myeloid/monocytic markers. We conclude that blast crisis in chronic myeloid leukemia occurs in Saudi patients in a pattern similar to that seen in patients elsewhere, and that surface Ia antigen positivity in lymphoblast cells is a reliable marker for differentiating lymphoid from nonlymphoid crisis, in which the Ia antigen is not usually demonstrable.

Reply

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described the morphological and immunophenotypic patterns of blastic transformation in Saudi patients with chronic myeloid leukemia CML [1]. He points out that the relatively young age of our patients contrasts with his own observations at the Asir Central Hospital in Abha.

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Risk Factors and Prognosis of Chronic Myeloid Leukemia in Saudi Arabia: A Systematic Review

“…One study was prospective in nature [9], and six were retrospective in nature [10][11][12][13][14][15]. Three studies were conducted in Riyadh [9,11,15], one in Abha [10], one in Mecca [12], one in Jeddah [13], and one in Al-Khobar [14]. This study demonstrated the long-term efficacy and controllable side effects of imatinib on CML [12][13][14].…”

“…Our results included seven studies with a total of 658 patients, and 357 (54.3) were males. One study was prospective in nature [9], and six were retrospective in nature [10][11][12][13][14][15]. Three studies were conducted in Riyadh [9,11,15], one in Abha [10], one in Mecca [12], one in Jeddah [13], and one in Al-Khobar [14].…”