Case 271 -- Chronic Myeloid Leukemia (CML)

Contributed by Rajendra Persad, MD
Published on line in June 2001


The patient is a 58 year old white female who was diagnosed with Chronic Myeloid Leukemia (CML) positive for the Philadelphia chromosome by classical cytogenetics, seven months previously. A repeat bone marrow performed five months after diagnosis, to assess response to interferon and hydroxyurea treatment findings consistent with CML, with persistence of the Ph chromosome and less than 1% blasts. She is now being evaluated prior to bone marrow transplant.

PB Count:

The peripheral smear demonstrated increased numbers of neutrophils and neutrophil precursors (Images 1 and 2), basophilia (Image 3) and occasional blasts with high N:C ratio, and inconspicuous nucleoli (Image 4). The red cells showed mild anisocytosis and poikilocytosis.

A bone marrow aspirate (Images 5, 6, 7 and 8) and biopsy was performed (Images 9 and 10) with the following differential:

The biopsy demonstrated marked cellularity (~100%), with many blasts. Erythroid maturation is slightly megaloblastoid. Myeloid maturation showed left shift. Occasional micromegakaryocyte were identified.

Flow Cytometry:

Flow cytometric immunophenotypic studies (images xi, xii and xiii) demonstrated a population of cells with B-cell lineage phenotype (Positive for CD34, CD19, CD10 and TdT). These constituted 19% of the total cells (Images 11, 12, 13, 14).

Flow Cytometry:

Ph chromosome positive (Image 15)


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