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Low BCR ABL High WBC at Diagnosis

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1 month 1 week ago #1839 by tjay
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%)?
  • Ehab Atallah
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1 month 1 week ago - 1 month 1 week ago #1841 by Ehab Atallah
Replied by Ehab Atallah on topic Low BCR ABL High WBC at Diagnosis
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)
Last edit: 1 month 1 week ago by arlene.
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