Acute Myeloid Leukemia with BCR::ABL1+ Fusion: A Report of Two Cases and Review of Literature.

Introduction: BCR::ABL1+ fusion is associated with chronic myelogenous leukemia and precursor B acute lymphoblastic leukemia. Though rare, there has been continued reporting of acute myeloid leukemia (AML) with BCR::ABL1+ fusion. We report two such cases.

Case presentations: The first is a 38-year-old male, who has been human immunodeficiency virus positive since 2004, with leukocytosis and numerous circulating blasts that showed evidence of a BCR::ABL1+ fusion rearrangement in the 91% of the cells analyzed via fluorescence in situ hybridization. He responded well to tyrosine kinase inhibitor combined chemotherapy. He was free of disease at 2 years of treatment but showed minimal residual disease at the molecular level 6 years after initial presentation. The second is a 69-year-old female with anemia, thrombocytopenia, and 25% circulating blasts. Her flow cytometric analysis revealed a CD34+ and CD117+ immature myeloid blast population. Her initial cytogenetic analysis showed t(9;22) translocation with loss of chromosomes 12 and 17, derivative of chromosome 1, pericentric inv(17), and two small marker chromosomes. Reverse transcription polymerase chain reaction revealed p190 and p210 BCR::ABL1+ fusion transcripts. She received multiple combinations of chemotherapy, consisting of dasatinib, cytarabine, and idarubicin. The patient showed persistent disease at 18 months of therapy with detectable BCR::ABL1+ transcripts in peripheral blood. The complex genetic profile of her cancer is likely the reason for her poor response, compared to the first patient. She was lost to follow-up.

Conclusion: With ever improving therapy available and few cases in the literature, correct and timely diagnosis with proper management of AML with BCR::ABL1+ is warranted.