Translate page

× 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 (no more than 200 words) by posting it in this forum ("New Discussion" button below). Please include the country of origin.

Each clinical case will be forwarded to the expert clinical panel for a brief independent response. Consideration should be given to patient confidentiality. Details that are not critical to the case can be changed to preserve anonymity. Please consider including your email with the case. This will not be posted on the website, but is useful should further details be requested by the moderator.

As a full clinical history is necessary for accurate comment, cases and comments on the Forum are ONLY ACCEPTED FROM PHYSICIANS. If individual patients have a specific question we encourage them to contact their healthcare provider. General questions can be emailed to

DISCLAIMER: The iCMLf does not recommend or endorse any specific tests, physicians, products, procedures, or opinions, and disclaims any representation, warranty, or guaranty as to the same. Reliance on any information provided in this Forum is solely at your own risk.

Low BCR ABL High WBC at Diagnosis

2 years 11 months 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
  • Ehab Atallah's Avatar
2 years 10 months ago - 2 years 10 months 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)

Ehab Atallah (Wisconsin, USA)
Last edit: 2 years 10 months ago by arlene.
Moderators: Nicolaarlene