The occurrence of the philadelphia chromosome in essential thrombocytosis

Unusual chromosome aberration, t(13;14)(q32;q32.3), in a case of essential thrombocythemia with extreme thrombocytosis

A case of essential thrombocythemia (ET) with extreme thrombocytosis in a 70-year-old male patient is described. The cytogenetic analysis revealed a pathologic clone with the following previously unreported, unusual karyotype: 46,XY,t(13;14)(q32:q32.3) and pericentric inversion of chromosome 9. The possible association of t(13;14) with the high platelet count is discussed.

Marrow fibrosis associated with a Philadelphia chromosome

Three patients had marked marrow fibrosis and an apparent Philadelphia (Ph) chromosome. Hematologic, cytogenetic, and molecular studies demonstrated the heterogeneity of such cases, including the first example of clinically typical myelofibrosis (MF) associated with a bcr gene rearrangement characteristic of chronic myelogenous leukemia (CML).

Cytogenetic analysis in essential thrombocythemia at diagnosis and at transformation. A 12-year study

Between 1979 and 1988, 86 patients with clinical and laboratory findings consistent with essential thrombocythemia (ET) were karyotyped at diagnosis. Four patients showed a Philadelphia chromosome and underwent myeloid blastic crisis 2.5-4.5 years later, strongly suggesting a diagnosis of chronic myeloid leukemia. A partial deletion of 13q was seen in another case evolving to leukemia a few months later. Five cases, with normal karyotypes at diagnosis, developed acute transformation after more than 5 years of chronic phase. Four of them showed unusual clonal karyotype abnormalities involving different chromosomal regions. The numerical abnormalities found were trisomy 22 in one case, and trisomy 8 and 19 in another, while structural changes included partial deletion of 5p, partial deletion of 6q, pericentric inversion of chromosome 12, and partial deletion of 20q. These abnormalities have not been previously reported in ET. This investigation confirms the absence of a specific cytogenetic marker for ET, and the infrequent transformation to acute leukemia, often with chromosomal clonal disorders.

Philadelphia-positive thrombocythemia with a complex translocation involving chromosomes 9, 15, and 22

We report a case of Philadelphia chromosome (Ph) positive thrombocythemia with a complex translocation. G-banding analysis showed the predominant karyotype to be 46,XX,t(9;15;22). Southern blot analysis revealed a rearrangement within the breakpoint cluster region on chromosome 22 similar to findings in chronic myeloid leukemia. These data suggest the presence of a complex Ph translocation involving t(9;15;22)(q34.1 or q34.3;q26.1;q11 or q13).

Promyelocytic blast crisis of Philadelphia-positive thrombocythemia with translocations (9;22) and (15;17)

We report a promyelocytic blast crisis in a case of Ph-positive thrombocythemia with both t(9;22) and t(15;17). Our patient confirms the specificity of t(15;17) in malignant proliferation of promyelocytes and suggests its appearance as a second genetic event in the genesis of blast crisis occurring in a Ph-positive clone.

Trisomy 9 in hematologic disorders: possible association with primary thrombocytosis

Ten patients with a hematologic disorder and a clone of cells with trisomy 9 in the bone marrow were studied in order to investigate the clinical significance of this chromosome anomaly. In five of the patients, trisomy 9 was the only anomaly; in four, there was also trisomy 8; and in one, a Y chromosome was also lacking. Four patients had a myelodysplastic syndrome, and six had a myeloproliferative disorder. Interestingly, four patients had primary thrombocytosis.

Philadelphia chromosome positive essential thrombocythemia evolving into lymphoid blast crisis

The Philadelphia chromosome with the classic translocation t(9;22) was detected in all metaphases of a patient with essential thrombocythemia who presented without hematologic signs of chronic myeloid leukemia (CML). After 12 months of treatment with hydroxyurea followed by 6 months of busulfan, the disease transformed into lymphoid blast crisis with the immunophenotype of pre-pre-B cells frequently seen in lymphoid blast crisis of CML. This progression was not associated with karyotypic evolution because lymphoblasts contained only the Philadelphia chromosome. Further clinical course in this patient confirmed the development of a Philadelphia chromosome positive stem cell with predominantly megakaryocytic committment through partially megakaryocytic/lymphoid differentiation to purely lymphoid committment, a previously unreported transformation.