T‐lymphoblastic transformation of chronic myeloid leukemia
Bibliographic record
Abstract
An 85-year-old presented with abdominal pain and WBC count of 245.9 × 109/L with 26.9% blasts (66.39 × 109/L): neutrophils 110.66 × 109/L, eosinophils 12.30 × 109/L, basophils 0.0 × 109/L, metamyelocytes 7.38 × 109/L, myelocytes 17.22 × 109/L, lymphocytes 7.38 × 109/L, monocytes 24.59 × 109/L, hemoglobin 97 g/L, and platelets 107 × 109/L. Previous complete blood counts 3 years ago were normal. The blood film showed marked neutrophilia with leukoerythroblastosis, large platelets, and frequent medium-sized blasts with irregular nuclei (panel A, Wright-Giemsa stain; original magnification X200 and panel B; original magnification X500). Computed tomography abdomen showed splenomegaly. The patient deteriorated very rapidly and unfortunately passed away before a bone marrow biopsy was obtained. Apart from hydroxyurea, no further treatment was instituted. Flow cytometry of the blood specimen was performed 2 days post-hydroxyurea, since the pretreatment sample was too old upon receipt at our institution. The flow cytometry result showed two blast populations. The first population (6%) is positive for cCD3, CD5, CD7, CD4, partial CD2, partial CD117, and negative for CD34 and other myeloid/B-cell antigens (panel C; green population), consistent with T lymphoblasts. There is also a smaller population of blasts (2%) showing myeloid phenotype (panel C; red population), which is favored to be normal left shifted myeloblasts. Cytogenetic analysis demonstrated a complex karyotype with BCR/ABL1 rearrangement in all 10 metaphases examined:: 46,XY,del(8)(q12q21.3),add(9)(q34),del(11)(q23q24), der(14)(14pter → 14q32::?::22q11.2 > 22qter), der(22)t(9;22)(q34;q11.2)[10]. Fluorescence in situ hybridization confirmed BCR/ABL1 fusion in 132/200 nuclei. Given the proportion of cells positive for BCR/ABL1 fusion, myeloid predominance, and smaller fraction of T lymphoblasts, diagnosis of T-lymphoblastic transformation in the background of chronic myeloid leukemia (CML) is favored rather than de novo T-cell acute lymphoblastic leukemia (T-ALL) or mixed phenotype acute leukemia with t(9;22). The latter is much less common and does not usually present with myeloid hyperplasia and left shift, as seen in this case. Lymphoblastic transformation comprises 20-30% of CML blast phase, the majority being B-cell lineage. T-lymphoblastic transformation of CML is very rare with only a few reported cases worldwide and confers a very poor prognosis.1 Most cases have a prior history of CML and t(9;22) can be the sole cytogenetic abnormality or as a part of a complex karyotype.1 This case is unique since the patient presents with circulating T-lymphoblasts without a previous history of CML, which poses diagnostic dilemma between de novo T-ALL, mixed phenotype acute leukemia, or T-lymphoblastic phase of CML. The diagnosis in this case was even more challenging because patient deteriorated rapidly with no bone marrow biopsy obtained. However, the combination and careful assessment of blood film morphology, flow cytometry, and FISH analysis can aid with the diagnosis of T-lymphoblastic transformation of CML. The authors declare no conflict of interest. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".