# Case report: BCR-ABL-positive acute lymphoblastic leukemia with bone destruction: a treatment dilemma

## TL;DR

This case report describes a rare and challenging instance of BCR-ABL-positive ALL in an adult with bone destruction and hypercalcemia, highlighting treatment difficulties and the need for better therapies.

## Contribution

The paper presents a rare case of BCR-ABL-positive ALL in an adult with bone destruction and hypercalcemia as initial symptoms.

## Key findings

- The patient achieved remission with dasatinib but experienced recurrence with the T315I mutation.
- Bone destruction persisted despite treatment, indicating the need for more effective strategies.
- The patient eventually died from a severe pulmonary infection after relapse.

## Abstract

Although bone destruction and hypercalcemia without acute peripheral blast BCR-ABL-positive acute lymphoblastic leukemia (ALL) have been reported in children, they are rare in adults. Herein, we describe a case of BCR-ABL positive ALL with a triploid karyotype, WT1, and CDKN2A mutations with hypercalcemia and bone destruction as the first manifestations. Complete remission (CR) was achieved by induction chemotherapy. BCR-ABL turned negative after treatment with dasatinib. However, computed tomography and whole-body bone scan showed extensive bone destruction. Additionally, bone biopsy showed leukemic infiltration. After treatment with dasatinib and VMCP, leukemia recurred with positive BCR-ABL. The T315I mutation occurred. The patient was surgically diagnosed with calculous cholecystitis and achieved CR2 by postoperative orebatinib and VP regimens. Later, the patient died due to a severe pulmonary infection. BCR-ABL-positive ALL with bone destruction is rare and difficult to control using tyrosine kinase inhibitor chemotherapy alone. Therefore, further exploration of more effective treatments is needed.