Clinical Case Discussion Forum
To share and enhance best practice management of CML, experts and interested clinicians can discuss difficult or interesting CML cases here. Physicians submit a brief history of the patient and the case for discussion using this forum.
Low BCR ABL High WBC at Diagnosis
A 38 year old male, in a routine physical exam detected a very high WBC (197k), RBC, Hemoglobin and Platelets are okay. Completely asymptomatic.
On further examination, RT qPCR BCR ABL major p210 is detected at 0.1385% MR 2.86 before treatment.
Hypercellur bone marrow 100% cellularity, with left shifted granulocytic hyperplasia and mildly increased easinophils.
Blasts 0.4%, Myeloid 94.9% in Flow Cytometry Differential.
Lab results indicate CML in chronic phase, but how it's possible to have this low percentage of BCR-ABL before the treatment (0.1385%)?
I agree with you, it is very unusual to have this very low level BCR-ABL at diagnosis, with this amount of disease. I am assuming the karyotype did demonstrate the Philadelphia chromosome. I can think of two possibilities:
1-A lab error, and would suggest repeating the test
2-BCR-ABL variant, and would suggest a qualitative test for p190, p230, and other rare variants (maybe done at Mayo clinic)
Thanks,
Ehab Atallah (Wisconsin, USA)