A Case of B-Lineage Acute Lymphoblastic Leukemia with Blast Cell Using the White Precursor Cell (WPC)
DOI:
https://doi.org/10.30742/jikw.v15i2.5349Abstract
Background: Acute Lymphoblastic Leukemia (ALL) is a blood cancer driven by clonal proliferation of immature lymphoid precursors in the bone marrow and peripheral blood. One key cytogenetic feature is the Philadelphia chromosome (Ph), formed through t(9;22)(q34;q11.2), which generates the BCR-ABL1 fusion gene. The p210 isoform is mainly associated with Chronic Myeloid Leukemia (CML) and occurs in more than 90% of cases. Objective: This case report to highlight the clinical presentation of ALL mimicry with CML blast crisis, while the cellular blast profile can be distinguished using advanced hematological diagnostic technology through a novel parameter known as the White Blood Cell Precursor Channel signal. Case Presentation: A 31-year-old female presented to the hospital with complaints of dizziness and nausea. The dizziness had been present for one month prior to hospital admission. A diagnosis of blast-phase Chronic Myeloid Leukemia had been established two weeks earlier, based on detection of the BCR-ABL1 (p210) fusion gene. Additional diagnostic workup, including peripheral blood evaluation, bone marrow aspiration, and immunophenotyping, indicated B-cell Acute Lymphoblastic Leukemia (B-ALL). Result: The WPC channel demonstrated blast cells with large size and high RNA content, indicating a lymphoid lineage. Conclusion: . The WPC parameter provides a valuable adjunct in the diagnostic evaluation of leukemia.
Keywords: B-Acute Lymphoblastic Leukemia (B-ALL);); White Precursor Cell(WPC), Sysmex XR; Blast cell
References
Altaf, M., Khan, S. A., Khan, A., & Arsalan, A. (2021). Frequency of two transcripts of BCR-ABL1 fusion gene (p210 and p190) in acute lymphoblastic leukemia and chronic myeloid leukemia by reverse transcriptase polymerase chain reaction. Hematology & Transfusion International Journal, 9(1), 12–15. https://doi.org/10.15406/htij.2021.09.00244
Azambuja, A., Beltrame, M., Funke, V., Schluga, Y., Mion, A., …& Pasquini, R. (2024). Philadelphia acute lymphoblastic leukemia (Ph+ ALL) or blastic crisis of chronic myeloid leukemia (CML-BC)? Hematology, Transfusion and Cell Therapy, 46, S201. https://doi.org/10.1016/j.htct.2024.09.337
Bogdanov, K. V, Kudryavtseva, E. S., Lobacheva, Y. N., Merzlikina, O. V, & Mirolyubova, Y. V. (2025). The Emergence of a Novel Insertional Mutation in the BCR :: ABL / p210 Oncogene in B-Cell Acute Lymphoblastic Leukemia ( B-ALL ) Correlates with the Development of Resistance to Several Tyrosine Kinase Inhibitors. Acta Naturae, 17(65), 52–57. https://doi.org/10.32607/actanaturae.27539
Budiyono, F., Firman, A., Setiati, R., & Rah, E. (2024). Investigates the genetic types of acute lymphoblastic leukemia in full remission Indonesian patients: a cross-sectional analysis. American Journal of BioMedicine, 12(1), 43–51. https://doi.org/10.18081/2333-5106/2024.12/43
Ciesielska, M., Orzechowska, B., Gamian, A., & Kazanowska, B. (2024). Epidemiology of childhood acute leukemias. Advances in Hygiene and Experimental Medicine, 78(1), 22–36. https://doi.org/10.2478/ahem-2023-0023
Du, M., Chen, W., Liu, K., Wang, L., Hu, Y., …& Ye, D. (2022). The global burden of leukemia and its attributable factors in 204 countries and territories: Findings from the Global Burden of Disease 2019 Study and projections to 2030. Journal of Oncology, 2022, 1612702. https://doi.org/10.1155/2022/1612702
Fan, H., Yang, Y., Lu, Y., Li, J., Huang, Z., …& Zhou, B. (2025). Global burden of acute lymphoblastic leukemia following the COVID-19 pandemic. Annals of Hematology, 104(9), 4713–4727. https://doi.org/10.1007/s00277-025-06639-w
Garniasih, D., Susanah, S., Sribudiani, Y., & Hilmanto, D. (2022). The incidence and mortality of childhood acute lymphoblastic leukemia in Indonesia : A systematic review and meta-analysis. 1–13. https://doi.org/10.1371/journal.pone.0269706
Haider, M. S., Mahmood, A., Akhtar, F., Mahmood, R., Muzafar, S., & Bukhari, M. B. (2022). BCR-ABL1 gene mutation in acute lymphoblastic leukemia. Annals of Pakistan Institute of Medical Sciences, 18(3), 181–185. https://doi.org/10.48036/apims.v18i3.629
Hamad, M.A. (2022). Contribution of BCR-ABL molecular variants and leukemic stem cells in response and resistance to tyrosine kinase inhibitors: A review. F1000Research, 10, 1288. https://doi.org/10.12688/f1000research.74570.2
Hu, Y., Liu, Y., Fu, J., Liu, Y., Wang, H., & Song, Y. (2024). Global, regional, and national burden of acute lymphoblastic leukemia in children: Epidemiological trends analysis from 1990 to 2021. ISCIENCE, 27(12), 111356. https://doi.org/10.1016/j.isci.2024.111356
Jerez, J., Goldschmidt, V., Carolina, M., Torres, C., & Gazitúa, R. (2024). Epidemiological and clinical characteristics of adult acute lymphoblastic leukemia patients in Chile : A single-center analysis. Leukemia Research Reports, 21(2024), 100405 https://doi.org/10.1016/j.lrr.2023.100405
Liao, H., Lai, H., Chen, J., Shuai, X., Zhang, X., …& Zheng, Q. (2023). Prognostic value of cross-lineage expression of the myeloid-associated antigens CD13 and CD33 in adult B-lymphoblastic leukemia: A large real-world study of 1005 patients. Cancer Medicine, 12(8), 9615–9626. https://doi.org/10.1002/cam4.5739
Mohamed, A. N., Patel, M., Zureigat, H., Nurse, D. P., Haddad, S. F., …& Mukherjee, S. (2024). Impact of P190 and P210 BCR::ABL1 Chimeric Protein on Outcomes of Acute Lymphoblastic Leukemia at a Tertiary Center. BLOOD, 144(November), 5909. https://doi.org/10.1182/blood-2024-202558
Momen, N., Baysal, B., Sait, S.J, Tario, J., Qian, Y.W. (2022). Unusual B-lymphoid blast crisis as initial presentation of chronic myeloid leukemia imposes diagnostic challenges. Case Rep Hematol, 9785588. https://doi.org/10.1155/2022/9785588
Ningombam, A., Acharya, S., Sarkar, A., Kumar, K., Chopra, A. (2021). Scattergram Patterns of Hematological Malignancies on Sysmex XN‑Series Analyzer. Journal of Applied Hematology, 12(2), 83-89. https://doi.org/10.4103/joah.joah_176_20
Outersterp, I. V., Boer, J. M., Ven, C., Reichert, C. E. J., Boeree, A., …& Boer, M. L. (2024). Tyrosine kinase inhibitor resistance in de novo BCR :: ABL1 – positive BCP-ALL beyond kinase domain mutations. BLOOD ADVANCES, 8(8), 1835–1845. https://doi.org/10.1182/bloodadvances.2023012162
Pamuk, G. E., & Ehrlich, L. A. (2024). An Overview of Myeloid Blast-Phase Chronic Myeloid Leukemia. Cancers, 16(21), 3615. https://doi.org/10.3390/cancers16213615
Pepeler, M. S., Oztürk, F., Okumus, N., Dal, M. S., Yaman, S., …& Dağdas, S. (2026). Prognostic differences between p190 and p210 BCR::ABL1 in patients with Philadelphia-positive B-cell acute lymphoblastic leukemia. Indian Journal of Hematology and Blood Transfusion, 42(1), 110–119. https://doi.org/10.1007/s12288-025-02095-8
Raharjo, B., Gunawan, C. K., Linggawan, S., Ugroseno, S., Bintoro, Y., Sumarpo, A. (2025). B-cell acute lymphoblastic leukemia and lymphoblastic lymphoma with p190 BCR :: ABL1 transcript : a case report. Journal of Medicine and Life, 18(6), 600–603. https://doi.org/10.25122/jml-2025-0020
Rahmat, R., Tjong, D. H., Almurdi, A., & Wulandari, M. (2022). Nilai leukosit, eritrosit, dan trombosit pada penderita leukemia limfoblastik akut pasien anak. Jurnal Kesehatan Perintis, 9(2), 76–81. https://doi.org/10.33653/jkp.v9i2.863
Ratnasari, N., Hajat, A., & Bintoro, S. U. Y. (2020). Diagnostic Value of Determination Blast Cell Population Lineage Using WPC Scattergram Hematology Analyzer. Indonesian Journal of Clinical Pathology and Medical Laboratory, 26,3(Sep.2020), 328–333. https://doi.org/10.24293/ijcpml.v26i3.1585
Senapati, J., Jabbour, E., Kantarjian, H. et al. Pathogenesis and management of accelerated and blast phases of chronic myeloid leukemia. Leukemia 37, 5–17 (2023). https://doi.org/10.1038/s41375-022-01736-5
Shah, S., Kundu, R., Mishra, R., Mukherjee, S., & Singh, A. (2024). A rare case of Philadelphia-positive (P210 BCR-ABL1) T-cell acute lymphoblastic leukemia/lymphoma associated with minimal residual disease persistence after intensive chemotherapeutic approaches. Leukemia Research Reports, 21, 100456. https://doi.org/10.1016/j.lrr.2024.100456
Shi, T., Xie, M., Chen, L., Yuan, W., Wang, Y., …& Zhu, H. (2022). Distinct outcomes, ABL1 mutation profile, and transcriptome features between p190 and p210 transcripts in adult Philadelphia-positive acute lymphoblastic leukemia in the TKI era. Experimental Hematology & Oncology, 11(1), 13. https://doi.org/10.1186/s40164-022-00265-2
Suwandari, N. L. A., Lestari, A. A. W., Wande, I. N., Wirawati, I. A. P., & Prabawa, I. P. Y. (2023). Acute lymphoblastic leukemia (ALL)-L2 in an adult woman: A case report. Bali Medical Journal, 12(1), 669–674. https://doi.org/10.15562/bmj.v12i1.3934
Tebbi, C. K. (2021). Etiology of acute leukemia: A review. Cancers, 13(9), 1–19. https://doi.org/10.3390/cancers13092256
Wang, L., Li, L., Chen, R., Huang, X., & Ye, X. (2021). Understanding and monitoring chronic myeloid leukemia blast crisis: How to better manage patients. Cancer Management and Research, 13, 4987–5000. https://doi.org/10.2147/CMAR.S314343
Werner, P.S., Kohlschein, P., Maroz, A., Linssen, J., Dreißiger, K., Burstein, C. (2016). Performance of the XN-2000 WPC channel-flagging to differentiate reactive and neoplastic leukocytosis" Clinical Chemistry and Laboratory Medicine (CCLM), 54(9), 1503-1510. https://doi.org/10.1515/cclm-2015-1105
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