Persistent neutropenia in chronic myelogenous leukemia in chronic phase treated with imatinib mesylate

A 48-year-old woman presented with left upper abdominal pain. Physical examination showed pallor and a 6-cm splenomegaly. The full blood count showed hemoglobin: 8.4 g/dL, white cell count: 144 x 10 9 /L, and platelet count: 982 x 10 9 /L. The blood smear showed a bimodal increase in myelocytes and neutrophils, with eosinophilia and basophilia. Bone marrow aspirate was markedly hypercellular with granulocytic hyperplasia and no increase in blasts. Megakaryocytes were small and hypolobated. Morphologic features were consistent with chronic myelogenous leukemia (CML) in chronic phase. However, cytogenetic analysis only showed 46, XX, inv(9)(p11q13).