Quick Case: Biphenotypic blast crisis in CML in a young female

Biphenotypic blast crisis is not so common. If chronic myelomonocytic leukemia (CML) is undetected, and the patient first presents with features of acute leukemia, it is difficult to distinguish it from acute myelomonocytic leukemia. I recently dealt with a case of a 30-year-old female with 46% blast in peripheral blood, moderate hepatosplenomegaly and a very high level of BCR-ABL transcript protein. Two distinct types of blasts were noted: granular larger MPO-positive blasts and smaller agranular MPO-negative blasts with no vacuoles, but irregular nuclear contour with very high N:C ratio. Flow cytometry revealed EGIL score (myeloid at least 3 and T-lymphoid at least 3.5). The patient well responded to imatinib therapy.

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