Rapid Progression From Chronic Phase to Blast Crisis: Prognostic Implications of Bone Marrow Fibrosis in Chronic Myeloid Leukemia
DOI:
https://doi.org/10.31436/imjm.v25i03.2931Keywords:
chronic myeloid leukaemia, bone marrow fibrosis, tyrosine kinase inhibitor, adolescent, blast crisisAbstract
Chronic myeloid leuka;emia (CML) demonstrates variable responses to tyrosine kinase inhibitors (TKI). The prognostic impact of bone marrow fibrosis (BMF), particularly at diagnosis, remains under-recognised, especially in adolescent patients. We report a case of a 14-year-old male diagnosed with chronic-phase CML who progressed rapidly to blast crisis within 12 months. Despite treatment with imatinib followed by nilotinib, the patient failed to achieve a complete cytogenetic response due to severe cytopenia and frequent dose interruptions. Retrospective analysis of the initial bone marrow biopsy revealed grade 3 fibrosis. The disease remained refractory despite high-dose induction chemotherapy. This case highlights the potential prognostic relevance of BMF in adolescent CML and supports the integration of reticulin staining into the diagnostic workup to guide timely intervention.
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