Progression and prognosis of chronic myelogenous leukemia in the acute stage: hematologic and cytogenetic aspects

Therapeutic and prognostic value of chromosomal AP classification at the blastic phase of Ph-positive chronic myeloid leukemia: comparison of data from Nagasaki University, Japan and Roswell Park Memorial Institute, U.S.A

To assess parameters of therapeutic response and survival after the onset of the blastic phase (BP) in 47 patients with Philadelphia chromosome (Ph)-positive chronic myeloid leukemia (CML), a number of clinical hematologic, and cytogenetic data at the BP were evaluated. Among the eleven parameters examined, only the chromosomal findings correlated with the therapeutic response and survival after onset of the BP. The patients were divided into three groups on the basis of the chromosome findings in the bone marrow: one, with only a Ph (PP), another with two different clones, i.e., one clone with Ph only and another with additional karyotypic changes (AP), and a third group with only abnormal clones containing karyotypic abnormalities in addition to the Ph (AA). The number of patients with AA was 12, 18 with AP, and 17 with PP. The results were as follows: (1) The percentage of patients with a good therapeutic response was 25% (3/12) in AA, 22% (4/18) in AP, and 76% (13/17) in PP; (2) The median survival after the onset of the BP was 1.5 mo for AA, 2.4 mo for AP, and 7.3 mo for PP. Statistically, there was a significant difference between PP and the other two groups (p < 0.05). These data were reevaluated and compared to those of 64 patients with Ph-positive CML in Roswell Park Memorial Institute (RPMI) who had been reported earlier in 1983.

Cytogenetic studies in blast crisis of Ph-positive chronic granulocytic leukemia: results and prognostic evaluation in 52 patients

Bone marrow cytogenetic (G-banding) studies were carried out in 52 patients with Ph-positive chronic granulocytic leukemia (CGL) at the time of diagnosis of blast crisis. In all cases, the Ph chromosome was due to the standard (9;22) translocation. Eighteen patients displayed the 46,Ph cell line unchanged, whereas additional chromosome abnormalities were observed in the remaining 34 patients (65.4%). Among the latter, numerical karyotypic changes were found in 31 patients and structural changes in 8 patients. Five patients displayed numerical and structural changes simultaneously. The most common chromosome numerical changes were an extra #8 (14 cases) and additional Ph chromosomes (11 patients); an i(17q) was the most frequently observed structural change (3 cases). These three aberrations were often combined; at least one of them was present in 21 patients, constituting 62% of the cases with new cytogenetic abnormalities at blast crisis. When comparing the clinical and hematologic characteristics, as well as the survival, of patients retaining the unchanged 46,Ph cell line and patients showing additional chromosome changes, no differences were found between the two groups of patients. However, a minority displaying a hypodiploid modal chromosome number survived significantly longer than the remaining patients.

Chromosomal abnormalities in lymphoid crisis of chronic myelogenous leukemia

The karyotypes in six patients with Ph-positive chronic myelogenous leukemia (CML) were investigated during the lymphoid crisis associated with high levels of terminal deoxynucleotidyl transferase (TdT) and/or the common acute lymphoblastic antigen (CALLA). Five of the six patients had only the Ph chromosome, with no other karyotypic abnormalities. The remaining one patient had a hypodiploid karyotype: 44,XY, -1, + der(1;?)(p22;?), -3, -4, -6, -7, -8, -9, +22q-, + mar1, + mar2, + mar3. In four patients with lymphoid crisis expressing TdT and CALLA, the response to treatment with vincristine (VCR) and prednisolone (PRD) was satisfactory, except for the one patient whose karyotype was hypodiploid. A discussion is presented as to whether or not there is a correlation between the karyotypic changes, using banding methods, and TdT expression in patients whose blast cells were categorized morphologically as lymphoblastic at the onset of the blastic phase of CML. Sequential chromosome examinations during the chronic and blastic phases of CML were also performed in this study.

Investigations on karyotype evolution in patients with chronic myeloid leukemia (CML)

In an attempt to relate karyotype evolution to clinical and hematological data serial chromosomal analyses were performed in 31 patients with chronic myeloid leukemia (CML), both in chronic and acute phases. Our results in Philadelphia chromosome (Ph1)-positive CML are in line with karyotype profiles described in the literature. In addition, we report on chromosomal findings in 4 cases of Ph1-negative disease, one presenting with an iso17q chromosome in the positive CML. The same chromosomal abnormality was observed in a small population of Ph1-negative cells present in one of two patients with mixed Ph1-positive/Ph1-negative CML. The first case of a female patient with the loss of a sex chromosome in Ph1-positive cells is reported. Two patients with unusually long and mild chronic phases despite the presence of trisomy 8 in their karyotypes are described. Our findings suggest that the order of appearance of additional chromosomal changes of CML is of prognostic significance for the progression and the clinical picture of the disease.

Chromosomes and causation of human cancer and leukemia. IL. Therapeutic and prognostic value of chromosomal findings during acute phase in Ph1-positive chronic myeloid leukemia

The therapeutic response and survival after the onset of the acute crisis in 64 patients with Ph1-positive chronic myeloid leukemia (CML) were correlated with the chromosomal findings during the course of the acute phase. The patients were divided into three groups on the basis of the chromosome findings in the bone marrow, blood, and spleen: i.e. those with only a Ph1 (PP), those having two types of clones, i.e. one clone with only a Ph1 and another with additional karyotypic changes (AP), and those with only abnormal clones containing karyotypic abnormalities in addition to the Ph1 (AA). The number of patients in each group was: 22 in PP, 25 in AP and 17 in AA. The results were as follows: (1) The percentage of patients with a good therapeutic response was 77 per cent (17/22) in PP, 60 per cent (15/25) in AP and 29 per cent (5/17) in AA and 2). The median survival after the onset of the acute crisis was 148 days (4.9 months) in PP, 183 days (6.1 months) in AP and 53 days (1.8 months) in AA. Statistically, there was a significant difference between the AA and the other two groups (P less than 0.001). Our observations suggest that the lack of a clone with only a Ph1 during the course of the acute phase (AA) indicates an unfavourable response and a poor prognosis after the onset of the acute crisis in CML.

Different Kinetic Pattern of Chronic Myeloid Leukemia: Lymphoblastic and Myeloblastic Blastic Crisis

Cell kinetic studies were performed in 8 ease of lymphoid blastic crisis (BC) of chronic myeloid leukemia at the onset of BC and during subsequent relapses. The results were compared with those found in 7 myeloblastic BC. While in the myeloblastic transformation the labeling index (LI) was always higher in bone marrow than in peripheral blood blasts, suggesting a predominant bone marrow proliferation of the leukemic cells, in the lymphoid transformation a higher LI was often found in peripheral blasts. Moreover, the lymphoblastic transformations were frequently characterized by lymphadenopathy. These findings point to the similarities between lymphoid BC and acute lymphoblastic leukemia, suggesting the possibility that a blastic event may originate in an extramedullary site and that an extramedullary BC is more likely to be lymphoid in nature.