Predicting early blast transformation in chronic-phase chronic myeloid leukemia: Is immunophenotyping the missing link?

Fuad El Rassi, John D. Bergsagel, Martha Arellano, Manila Gaddh, Anand Jillella, Vamsi Kota, Leonard T. Heffner, Elliott F. Winton, Hanna Jean Khoury

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

BACKGROUND: Flow cytometry (FC) is a commonly requested test in the workup of leukocytosis in community practices. The role of FC in chronic-phase chronic myeloid leukemia (CP-CML) is unknown. We hypothesized that finding aberrant cells with FC in CP-CML may predict early blast-phase (BP) transformation. METHODS: Results for FC performed at the time of diagnosis for adult and pediatric patients with CP-CML who were referred to our institution were reviewed, and they were correlated with outcomes. RESULTS: FC was performed at the time of diagnosis for 110 of 233 patients (47%) with CP-CML. Aberrant populations, representing a median of 2% (range, 0.3%-15%), were detected with FC in 30% of patients (33 of 110): 2 of these 33 patients expressed lymphoid markers, and 31 expressed aberrant myeloid markers. Patients received imatinib (85%), dasatinib (12%), or nilotinib (3%) as their first-line treatment. With a median follow-up of 43 months (range, 2-113 months), chronic myeloid leukemia transformed to BP in 5 of the 33 patients. The 2 patients with lymphoid markers and 3 of the 31 patients with aberrant myeloid markers experienced a transformation to lymphoid BP at a median of 11 months (range, 4-72 months) after the initiation of tyrosine kinase inhibitor therapy. Although both cases with detectable lymphoid markers rapidly progressed to lymphoid BP, the positive predictive value of BP transformation by the detection of myeloid aberrant cells with FC was only 10% (3 of 31). CONCLUSIONS: In contrast to aberrant myeloid markers, the detection of lymphoid markers by FC at the time of the diagnosis of CP-CML appears to be associated with early progression to lymphoid BP.

Original languageEnglish (US)
Pages (from-to)872-875
Number of pages4
JournalCancer
Volume121
Issue number6
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Leukemia, Myeloid, Chronic Phase
Immunophenotyping
Lymphocyte Activation
Blast Crisis
Flow Cytometry
Leukocytosis
Myeloid Cells
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Protein-Tyrosine Kinases
Pediatrics

Keywords

  • Chronic myeloid leukemia (CML)
  • Chronic phase
  • Early blast phase
  • Flow cytometry

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Predicting early blast transformation in chronic-phase chronic myeloid leukemia : Is immunophenotyping the missing link? / El Rassi, Fuad; Bergsagel, John D.; Arellano, Martha; Gaddh, Manila; Jillella, Anand; Kota, Vamsi; Heffner, Leonard T.; Winton, Elliott F.; Khoury, Hanna Jean.

In: Cancer, Vol. 121, No. 6, 01.01.2015, p. 872-875.

Research output: Contribution to journalArticle

El Rassi, F, Bergsagel, JD, Arellano, M, Gaddh, M, Jillella, A, Kota, V, Heffner, LT, Winton, EF & Khoury, HJ 2015, 'Predicting early blast transformation in chronic-phase chronic myeloid leukemia: Is immunophenotyping the missing link?', Cancer, vol. 121, no. 6, pp. 872-875. https://doi.org/10.1002/cncr.29142
El Rassi, Fuad ; Bergsagel, John D. ; Arellano, Martha ; Gaddh, Manila ; Jillella, Anand ; Kota, Vamsi ; Heffner, Leonard T. ; Winton, Elliott F. ; Khoury, Hanna Jean. / Predicting early blast transformation in chronic-phase chronic myeloid leukemia : Is immunophenotyping the missing link?. In: Cancer. 2015 ; Vol. 121, No. 6. pp. 872-875.
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title = "Predicting early blast transformation in chronic-phase chronic myeloid leukemia: Is immunophenotyping the missing link?",
abstract = "BACKGROUND: Flow cytometry (FC) is a commonly requested test in the workup of leukocytosis in community practices. The role of FC in chronic-phase chronic myeloid leukemia (CP-CML) is unknown. We hypothesized that finding aberrant cells with FC in CP-CML may predict early blast-phase (BP) transformation. METHODS: Results for FC performed at the time of diagnosis for adult and pediatric patients with CP-CML who were referred to our institution were reviewed, and they were correlated with outcomes. RESULTS: FC was performed at the time of diagnosis for 110 of 233 patients (47{\%}) with CP-CML. Aberrant populations, representing a median of 2{\%} (range, 0.3{\%}-15{\%}), were detected with FC in 30{\%} of patients (33 of 110): 2 of these 33 patients expressed lymphoid markers, and 31 expressed aberrant myeloid markers. Patients received imatinib (85{\%}), dasatinib (12{\%}), or nilotinib (3{\%}) as their first-line treatment. With a median follow-up of 43 months (range, 2-113 months), chronic myeloid leukemia transformed to BP in 5 of the 33 patients. The 2 patients with lymphoid markers and 3 of the 31 patients with aberrant myeloid markers experienced a transformation to lymphoid BP at a median of 11 months (range, 4-72 months) after the initiation of tyrosine kinase inhibitor therapy. Although both cases with detectable lymphoid markers rapidly progressed to lymphoid BP, the positive predictive value of BP transformation by the detection of myeloid aberrant cells with FC was only 10{\%} (3 of 31). CONCLUSIONS: In contrast to aberrant myeloid markers, the detection of lymphoid markers by FC at the time of the diagnosis of CP-CML appears to be associated with early progression to lymphoid BP.",
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T1 - Predicting early blast transformation in chronic-phase chronic myeloid leukemia

T2 - Is immunophenotyping the missing link?

AU - El Rassi, Fuad

AU - Bergsagel, John D.

AU - Arellano, Martha

AU - Gaddh, Manila

AU - Jillella, Anand

AU - Kota, Vamsi

AU - Heffner, Leonard T.

AU - Winton, Elliott F.

AU - Khoury, Hanna Jean

PY - 2015/1/1

Y1 - 2015/1/1

N2 - BACKGROUND: Flow cytometry (FC) is a commonly requested test in the workup of leukocytosis in community practices. The role of FC in chronic-phase chronic myeloid leukemia (CP-CML) is unknown. We hypothesized that finding aberrant cells with FC in CP-CML may predict early blast-phase (BP) transformation. METHODS: Results for FC performed at the time of diagnosis for adult and pediatric patients with CP-CML who were referred to our institution were reviewed, and they were correlated with outcomes. RESULTS: FC was performed at the time of diagnosis for 110 of 233 patients (47%) with CP-CML. Aberrant populations, representing a median of 2% (range, 0.3%-15%), were detected with FC in 30% of patients (33 of 110): 2 of these 33 patients expressed lymphoid markers, and 31 expressed aberrant myeloid markers. Patients received imatinib (85%), dasatinib (12%), or nilotinib (3%) as their first-line treatment. With a median follow-up of 43 months (range, 2-113 months), chronic myeloid leukemia transformed to BP in 5 of the 33 patients. The 2 patients with lymphoid markers and 3 of the 31 patients with aberrant myeloid markers experienced a transformation to lymphoid BP at a median of 11 months (range, 4-72 months) after the initiation of tyrosine kinase inhibitor therapy. Although both cases with detectable lymphoid markers rapidly progressed to lymphoid BP, the positive predictive value of BP transformation by the detection of myeloid aberrant cells with FC was only 10% (3 of 31). CONCLUSIONS: In contrast to aberrant myeloid markers, the detection of lymphoid markers by FC at the time of the diagnosis of CP-CML appears to be associated with early progression to lymphoid BP.

AB - BACKGROUND: Flow cytometry (FC) is a commonly requested test in the workup of leukocytosis in community practices. The role of FC in chronic-phase chronic myeloid leukemia (CP-CML) is unknown. We hypothesized that finding aberrant cells with FC in CP-CML may predict early blast-phase (BP) transformation. METHODS: Results for FC performed at the time of diagnosis for adult and pediatric patients with CP-CML who were referred to our institution were reviewed, and they were correlated with outcomes. RESULTS: FC was performed at the time of diagnosis for 110 of 233 patients (47%) with CP-CML. Aberrant populations, representing a median of 2% (range, 0.3%-15%), were detected with FC in 30% of patients (33 of 110): 2 of these 33 patients expressed lymphoid markers, and 31 expressed aberrant myeloid markers. Patients received imatinib (85%), dasatinib (12%), or nilotinib (3%) as their first-line treatment. With a median follow-up of 43 months (range, 2-113 months), chronic myeloid leukemia transformed to BP in 5 of the 33 patients. The 2 patients with lymphoid markers and 3 of the 31 patients with aberrant myeloid markers experienced a transformation to lymphoid BP at a median of 11 months (range, 4-72 months) after the initiation of tyrosine kinase inhibitor therapy. Although both cases with detectable lymphoid markers rapidly progressed to lymphoid BP, the positive predictive value of BP transformation by the detection of myeloid aberrant cells with FC was only 10% (3 of 31). CONCLUSIONS: In contrast to aberrant myeloid markers, the detection of lymphoid markers by FC at the time of the diagnosis of CP-CML appears to be associated with early progression to lymphoid BP.

KW - Chronic myeloid leukemia (CML)

KW - Chronic phase

KW - Early blast phase

KW - Flow cytometry

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DO - 10.1002/cncr.29142

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