An interesting case of chronic myeloid leukemia with twists and turns.

Additional cytogenetic abnormalities (ACA) are known to crop up in Ph cells of chronic myeloid leukemia (CML) patients due to cytogenetic evolution. But the frequency of molecular evolution and ACA is much less in Ph cells of CML patients and is poorly understood. We report an interesting and rare case of Ph CML, who progressed to B lymphoblastic crisis, achieved remission, and later developed Ph acute myeloid leukemia (AML) with KMT2A gene rearrangement and no detectable BCR- ABL transcripts.