Case Report: Presentation and management of extramedullary blast crisis presenting as retroperitoneal hematoma on a newly diagnosed CML patient
Introduction/Background/Significance: Chronic myelogenous leukemia (CML) is a hematopoietic stem cell disorder characterized by the Philadelphia chromosome translocation (BCR-ABL1), leading to abnormal hematopoiesis. Extramedullary blast crisis (BC) is a rare but severe manifestation, often associated with poor prognosis. The management of CML in a blast crisis typically involves tyrosine kinase inhibitors (TKIs), chemotherapy, and stem cell transplantation.
Materials and Methods/Case Presentation/Objective: A 20-year-old male newly diagnosed with CML, chronic phase. 1 week after initiation Imatinib 400 mg/day, he developed a large retroperitoneal hematoma, necessitating angiographic embolization, percutaneous drainage, and subsequent exploratory laparotomy, evacuation of hematoma, revealing myeloid sarcoma.
Results/Description/Main Outcome Measures: Patient was maintained on Imatinib 400mg once a day until G250E resistance was identified at 12th month of treatment. Patient was shifted to Nilotinib which resulted in deep molecular response at the 31th month of treatment
Conclusions: This case highlights a rare presentation of the extramedullary blast crisis of CML. Despite initial challenges, including complications from retroperitoneal hemorrhage, the patient achieved a favorable response to targeted therapy with TKI escalation and mutation-directed therapy. This case underscores the importance of close monitoring and timely therapeutic adjustments in the management of CML with blast crisis and extramedullary involvement using tyrosine kinase inhibitors.
