Acute erythroid leukemia with TP53 mutation and BCR/ABL1: challenges in classification and management

A 70-year-old female patient with no known medical history presented in our ER with irradiating lumbar pain. CBC revealed moderate leukocytosis (WBC 25,000/mm3), severe thrombocytopenia (16,000/mm3), and moderate anemia (9.5 g/dL). Bone marrow (BM) aspirate (Fig. 1) revealed an infiltrate of blasts negative for myeloperoxidase (MPO) representing 65% of BM cellularity and trilineage dysplasia, compatible with a morphologic diagnosis of acute erythroid leukemia (AEL). Urgent molecular assays were positive for BCR/ABL1. The patient’s clinical conditions rapidly deteriorated, and despite maximal broad-spectrum antibiotics and vasopressors, the patient later succumbed to urosepsis in the ICU.