VISUAL ABNORMALITIES AS THE FIRST SYMPTOM IN CHRONIC MYELOID
POSTER 23
LEUKAEMIA
Christopher J. Saunders1, Catarina Xavier2, Filipa Saraiva1, Paula Sousa e Santos1 and Patrícia Ribeiro1
(1)Serviço de Hematologia Clínica, Hospital dos Capuchos, Centro Hospitalar e Universitário Lisboa
Central, Lisboa, Portugal
(2)Serviço de Oftalmologia, Hospital dos Capuchos, Centro Hospitalar e Universitário Lisboa Central,
Lisboa, Portugal
Chronic myeloid leukaemia (CML) clinical presentation can vary from an incidental finding
during routine complete blood count to a symptomatic presentation with weight loss,
sweating or splenomegaly.
Ophthalmological manifestations in CML are rare and even more as a first presentation.
We report a case of a 30-year-old male with no previous medical history referring in the
previous 3 days a central blind spot in the right eye. Visual acuity was 2/10 and 10/10 in his
right and left eye(s), respectively. Right eye fundoscopic examination revealed vascular
changes with macular haemorrhage and retinal vein tortuosity. Optical coherence
tomography (OCT) and retinal angiography (RA) revealed bilateral retinal haemorrhage but
with foveal involvement in the right eye. Cardiac, autoimmune or blood dyscrasia were
excluded. Physical examination detected an assymptomatic splenomegaly. Laboratory
findings confirmed chronic phase CML: leukocytosis 500x109/L, normocytic normochromic
anemia 8,4 g/L, normal platelet count, myeloid hyperplasia with mature neutrophils,
myelocytes and 6% of blast cells in peripheral blood and bone marrow smear. Fluorescent in
situ hybridization (FISH) showed t(9;22) present in 89% of cells.
Cytoreduction therapy with hydroxyurea was started and after 14 days, leukocyte reduction
was accompanied by improvement of visual acuity and partial resolution of foveal
haemorrhage. Subsequently, the patient switched to imatinib 400mg daily and after 6 months
there was complete resolution of visual symptoms and complete haemorrhage absorption.
Studies have shown that nearly 10% of CML patients may present with ocular changes at
diagnosis. However, in our daily clinical practice, the usual ocular involvement defined by
retinal changes called leukemic retinopathy is under diagnosed. Although this case highlights
a rare type of leukemic retinopathy, it must not be forgotten that microvasculature occlusion
associated with hyperleukocytosis is a common event in CML.
Future studies are needed to determine a cut-off value for leukocytosis above which retinal
damage can be predicted and consequently better ophthalmology referrals of
myeloproliferative neoplasms, specially, CML.
SCIENTIFIC PROGRAMME
SESSION I
OPTIMIZING
CYTOREDUCTION
SESSION II
MANAGEMENT OF CML
WITH TKI
SESSION III
MPN RISK
STRATIFICATION
INCLUDING VASCULAR
EVENTS
DEBATE 1
INTERFERON ALPHA
SHOULD BE FRONT LINE
THERAPY IN ALL ET/PV
PATIENTS
ROUNDTABLE 1
INFECTIONS IN
MYELOPROLIFERATIVE
DISORDERS, INCLUDING
CML
ROUNDTABLE 2
PREGNANCY AND
PARENTING
DEBATE 2
ALLOGENEIC STEM CELL
TRANSPLANTATION
SHOULD BE CONSIDERED
THIRD LINE OPTION IN
CHRONIC PHASE CML
SESSION IV
EVOLVING THERAPIES
IN MYELOFIBROSIS
SESSION V
MANAGEMENT OF
ADVANCED AND UNUSUAL
DISEASE (MPN AND CML)
SESSION VI
TREATMENT FREE
REMISSION IN CML
KEYNOTE LECTURE
SELECTED ABSTRACTS
FOR AN ORAL
PRESENTATION
SELECTED ABSTRACTS
FO R A POSTER
PRESENTATION
DISCLOSURES