Bilineal Extramedullary Blast Crisis as an Initial Presentation of Chronic Myeloid Leukemia: A Case Report and Literature Review
Extramedullary T-lymphoblastic blast crisis of chronic myelogenous leukemia (CML) is uncommon and the prognosis is poor. It was usually misdiagnosed as the co-existence of T-lymphoblastic lymphoma (T-LBL) and CML. In the present study, we report a patient with CML, who developed extramedullary T-lymphoblastic blast crisis and was successfully treated with human leukocyte antigen (HLA)-mismatched stem cell transplantation. The patient was a 44-year-old man who presented with lymphadenectasis and leucocytosis prior to diagnosis. The bone marrow smear, biopsy and fluorescence in situ hybridization (FISH) of Breakpoint Cluster Region/ Abelson murine leukaemia (BCR/ABL) supported the diagnosis of CML in the chronic phase, while the immunohistochemistry of lymph nodes supported the diagnosis of T-LBL. The FISH test for BCR/ ABL in lymph node blast cells was performed and the result was positive; therefore, the patient was diagnosed with extramedullary T-lymphoblastic blast crisis of CML. After several courses of combined chemotherapy, the patient was treated with HLA-mismatched stem cell transplantation and obtained continuous remission for 51 months until the present (September 2013).