We report the case of a 49-year-old man who was diagnosed with chronic-phase CML in September 1999, and treated for 9 months with IFN- and cytarabine without cytogenetic response. Imatinib 600 mg p.o. o.d. was initiated in July 2000 and resulted in complete hematologic, cytogenetic and molecular remission, which was documented initially in August 2001. In November 2003, he disclosed a 10-month history of worsening left buttock pain. Physical examination revealed left inguinal lymphadenopathy and a soft tissue mass in the left iliac region. Computerized axial tomography of the abdomen and pelvis demonstrated a 9 cm mass destroying the left iliac wing, as well as left iliac lymphadenopathy (Figure 1). Biopsy of a left inguinal lymph node and of the left iliac soft tissue mass revealed CD34-positive myeloblasts. Fluorescent in situ hybridization of the iliac bone specimen identified major BCR/ABL b3a2 type consistent with extramedullary relapse of CML in myeloid blast phase. Surprisingly, there was no hematologic or cytogenetic evidence of relapse in a bone marrow sample obtained from the right posterior iliac crest, and peripheral blood was negative for BCR/ABL according to polymerase chain reaction.
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1 University of Connecticut Health Center, Farmington, CT 06030; 2 Eastern Connecticut Hematology/Oncology Associates Norwich, CT 06360; 3 St Francis Hospital and Medical Center, Hartford, CT 06105, USA
* Email: smaradottir{at}gme.uchc.edu
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