B-cell acute lymphoblastic leukemia (B-ALL) with the Philadelphia translocation-positive genotype (Ph+) is a high-risk leukemia subtype in older adults, where comorbidity often limits the use of intensive management and complicates clinical decision-making. We present the case of a 77-year-old female with progressive fatigue, dizziness, dyspnea, and palpitations, whose laboratory evaluation revealed symptomatic anemia and circulating blast cells. Peripheral smear and flow cytometry confirmed B-ALL, and fluorescence in situ hybridization (FISH) demonstrated BCR-ABL translocation. Cardiac examination revealed preserved systolic function with valvular disease and pulmonary hypertension, influencing treatment selection. Following a multidisciplinary tumor board discussion, the patient underwent reduced-intensity induction with mini-CVD (cyclophosphamide, vincristine, and dexamethasone) combined with dasatinib and central nervous system prophylaxis. Subsequent bone marrow examination demonstrated no morphologic or immunophenotypic evidence of residual leukemia, consistent with morphologic remission. The patient experienced clinical and hematologic improvement and was discharged on continuous tyrosine kinase inhibitor therapy with close monitoring. This case highlights the diagnostic workup, multidisciplinary treatment planning, and early therapeutic response in an elderly patient with Ph+ B-ALL while comparing these findings with the current literature.
Bidgoli et al. (Mon,) studied this question.