I discussed it with my colleagues from clinical hematology. First of all is it's is FNAC of excision of lymph node. As in FNAC blast may be missed. And also to look for history of infection for lymph nodes. And regard to treatment it is right option.

In our manuscript awaiting publication we have described lymphadenopathy in CPCML. These cases tend to be associated with lower peripheral blood wbc counts and lower absolute neutrophil counts than the average. We start them all on imatinib, but have not profiled their outcome in relation to the rest.

Interesting case, pretty uncommon. I’d do the same. Let us know how it turns out!

I believe that the choice of the drug is correct if the patient is in CP. I suggest only a close follow-up of all the superficial LN during the treatment.

Was the lymph node surgically excised, or was the diagnosis made via needle biopsy?

Was a PET scan performed to assess for hypermetabolic activity both at the site and elsewhere?

I would have considered consulting with radiation oncology to evaluate the potential role of local radiotherapy to the involved node or field.

Other than that, to my knowledge, there is limited data regarding the efficacy of asciminib in extramedullary disease. However, I agree that in a relatively young patient with an unusual site of extramedullary involvement, using a potent and novel agent like asciminib is a reasonable approach.

An alternative consideration could have been dasatinib, given its known activity in extramedullary sites and in blast phase CML. If this lymph node involvement is interpreted as a myeloid sarcoma, would that reclassify the disease as being in blast phase? This point might warrant further discussion.

Dear all, 

I am seeing a 52 year old, CP-CML. NGS normal. At time of presentation had a mammogram which demonstrated an enlarged LN. Biopsy from LN showed mature neutrophils and involvement by CML. No blasts. Started asciminib. Would you do anything different?

Thanks, 
Ehab