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.