A rare case of acute basophilic leukemia

Journal of Current Hematology:Oncology Case Report Research DOI: 10.51271/JCHOR-0016 A rare case of acute basophilic leukemia @Serhat Celik!, ®Muzaffer Keklik?, ®Olgun Kontas?, ®Mustafa Yavuz Koker4, @Leylagiil Kaynar’ ‘Department of Hematology, Yildirim Beyazit University Yenimahalle Training and Research Hospital, Ankara, Turkey 2Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Erciyes University, Kayseri, Turkey 3Department of Medical Pathology, Faculty of Medicine, Erciyes University, Kayseri, Turkey 4Department of Medical Pathology, Flow Cytometry Unit, Faculty of Medicine, Erciyes University, Kayseri, Turkey 5Department of Hematology, Faculty of Medicine, Medipol Mega University, Istanbul, Turkey Cite this article: Celik S, Keklik M, Kontas O, Koker MY, Kaynar L. A rare case of acute basophilic leukemia. J Curr Hematol Oncol Res. 202331(3):73-75. Corresponding Author: Serhat Celik, serhatcelikmd@gmail.com Received: 23/06/2023 ° Accepted: 11/07/2023 ° Published: 29/08/2023 ABSTRACT Acute basophilic leukemia is an extremely rare form of acute myeloid leukemia and diagnosis is based on morphological, cytochemical and ultrastructural analyses of basophils and blastic cells. It is usually characterized by a very rapid clinical course, symptoms of hyperhistaminemia and resistance to therapy. A 73 year-old male presented with itching, thrombocytopenia and leukocytosis. There was no hepatosplenomegaly. In the flow cytometry evaluation of peripheral blood, CD123 positive myeloid blasts were detected at the rate of 60%. Also, CD13 and CD33 were positive, while CD34, CD117, HLA DR and myeloperoxidase (MPO) were negative. These findings were considered as consistent with ABL. Following, the diagnosis of ABL was confirmed by bone marrow evaluation including cytomorphological and immunohistochemical studies. On the other hand, cytogenetical analyses of bone marrow showed the presence of the Philadelphia chromosome. The patient received one cycle of a chemotherapy regimen including cytarabine and idarubicin with imatinib support, but he died on the 10th hospital day. Considering that ABL behaves in a very malignant fashion, and a more aggressive treatment approach is necessary for patients with this specific subtype of AML. Keywords: Acute basophilic leukemia, CD123 antigen, flow cytometry INTRODUCTION Acute basophilic leukaemia (ABL) is an uncommon form of acute myeloid leukemia (AML) accounting for 4-5% of all cases.' Consistent diagnostic criteria for ABL still remain the topic of discussion. For diagnosis, it is necessary to exclude other hematological malignancies associated with basophilia such as chronic myeloid leukemia (CML), acute promyelocytic leukemia (APL) with basophilic differentiation, and AML/ myelodysplastic syndrome (MDS). On the other hand, most cases of ABL have been reported to be a consequence of the evolution from other leukemias. In most cases, the prognosis is poor. Here, we report a rare case of ABL with a very agressive clinical course. CASE A 73-year-old male presented to hematology department with itching lasting for 3 months. He had no past any medical history, family history and history of tobacco, alcohol, illegal drug use, and travel. Also his past medical history was negative for atopic diseases. His vital signs were blood pressure 110/70 mmHg, pulse 88/min, respiratory rate 23/ min, and body temperature 36.7 °C on admission. There was no hepatosplenomegaly or lymphadenopathy. Laboratory studies revealed the following: hemoglobin of 13.8 g/dl, white blood cells of 63x10°/L, and platelets of 84x10°/L. Serum biochemistry and coagulation were unremarkable. There were large population of basophils on the peripheral blood smear. Viral, bacteriological and autoimmune evaluations were normal. Also, cytomegalovirus, rubella virus, herpes simplex virus, varicella zoster virus, EpsteinBarr virus, hepatitis markers and brucellosis tests were found as negative. In addition, analysis to detect a parasitic infection or an atopic cause were negative. Spleen size was normal in the abdominal ultrasonography. Following, flow cytometry (FC) evaluation was performed by using FACS Calibur flow cytometer (Becton—Dickinson, Erembodegem, Belgium). In the FC evaluation of peripheral blood, CD123 positive myeloid blast cell group was detected at the rate of 60% of the total localized at CD 45 dim (Figure-1). CD4: CD8 ratio was 65:33. Also, CD13 and CD33 were positive, while CD34, CD117, HLA DR and myeloperoxidase (MPO) were negative. These results were considered as consistent with ABL. Following, bone marrow biopsy was performed, and the aspirate revealed high cellular marrow and most of the cells were CD13 and CD33 positive (Figure 2). This work is licensed under a Creative Commons Attribution 4.0 International License. BY NC NOD J Curr Hematol Oncol Res. 2023;1(3):73-75 CD38 AfS0 # CD23 PE CD1iz3 PE i CD38 A?50 Figure 1. Shown is the 60% of CD-123 positivity in flow cytometry