LETTERS TO THE EDITOR Double Minute CJu'omosomes and Monosomy 7 in a Lymphatic Blast Ca'isis of Chronic Myeloid Leukemia
The blast crisis (BC) of chronic myeloid leukemia (CML) is usually associated with abnormalities of chromosomes 8, 17, 19, and/or 22 [1]. In most published cases the BC has been of the myeloid type; little is known about the cytogenetic features of lymphatic BC. We report some unusual cytogenetic findings in the lymphatic BC of a CML patient. Chronic myeloid leukemia was diagnosed in a 71-year-old woman. Three years later, she entered the acute phase with 76% blasts in the bone marrow (BM). Peroxidase and a naphthol-acetate-esterase tests were concordant with a lymphoid BC. Chromosome analysis was performed on trypsin-Giemsa-banded preparations from short-term (24 and 48 hours) BM cultures. Twenty-five BM metaphases were analysed. Four af them showed t(9;22)(q34;q11) as the only abnormality. Among the remaining cells, three clones were observed with the following hypodiploid karyotypes: clone 1, 43-45,XX,t(9;22)(q34;q11),t(2;4;19)(:2q14-*2qter::4q11--~4qter: :19p13--~19q13),-7,inv(12)(p13q13); clone 2: 43-45,XX,t(9;22)(q34;q11),t(2;4;19) (:2q14--~2qter::4ql 1-~4qter::19q13--~19q13), - 7,inv(12)(p13q13), + drain; and clone 3, 43 -45,XX,t(9;22)(q34;q11),t(2;4;19)(:2q14--~2qter::4q11--~4qter::19p13--~19q13), + 4, - 7,inv(12)(p13q13), + dmin. A double minute (dmin) chromosome was detected in 12 metaphases (eight from clone 2 and four from clone 3). Figure 1 shows a representative karyotype of clone 2. Two cytogenetic findings are of interest: 1) the presence of monosomy 7, which appears to be associated with lymphoid transformation [1-4], and 2) the finding of a dmin chromosome, rarely described in CML. To our knowledge, only three cases have been reported until now, and all of them were compatible with lymphoid blast crisis [5-71. JUAN CRUZ CIGUDOSA MARIA JOSE CALASANZ ARTURO GULLON ITZIAR EZPELETA FRANCISCO JOSE OYARZABAL
Department of Genetics University of Navarra Pamplona, Spain Department of Hematology Hospital Virgel del Camino Pamplona, Spain
This work was supported by a grant from the Spanish Ministry of Science. The authors thank Professor F. Mitelman for constructive criticism of the manuscript.
133 © 1990 Elsevier SciencePublishingCo.. Inc. 655 Avenueof the Americas,New York,NY 10010
Cancer Genet Cytogenet48:133-134(1990) 0165-4608/90/$03.50
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F i g u r e 1 Representative karyotype of clone 2, showing the Ph chromosome, the derivative chromosomes 2, 4, 19, monosomy 7, inv(12}, and one drain. Monosomy 21 was not clonal. Structurally rearranged chromosomes (arrow}.
REFERENCES 1. Bernstein R (1988}: Cytogenetics of chronic myelogenous leukemia. Semin Hemato125:20-34. 2. O'Malley FM, Garson OM (1985}: Chronic granulocytic leukemia: Correlation of blastic transformation type with karyotypic evolution. Am J Hematol 20:313-323. 3, Parreira L, Kerany L, Rassol F, Babpu]le VB, Matures E, Parreira A, Tavares de Castro J, Goldman JM, Catovsky D (1986}: Correlation between chromosomal abnormalities and blast phenotype in the blast crisis of Ph'-positive CGL. Cancer Genet Cytogenet 22:29-34. 4. Diez-Martin IL, Dewald GW, Pierre RV (1988): Possible cytogenetic distinction between lymphoid and myeloid blast crisis in chronic granulocytic leukemia. Am J Hematol 27:19-203. 5. Alimena G, Dallapicola B, Gastaldi R, Mandelli F, Brandt L, Mitelman F, Nilsson PG (1982): Chromosomal, morphological and clinical correlations in blast crisis of chronic myeloid leukemia. A study of 69 cases. Scand J Haematol 28:103-117. 6. Uehara M, Kida M, Kamamura M (1987}: Rings and double minutes in a case with blastic phase of chronic myelocytic leukemia. Cancer Genet Cytogenet 25:253-258. 7. Mitelman F (1988): Catalog of Chromosome Aberrations in Cancer, 3rd Ed. Alan R. Liss, New York, p. 988.
The blast crisis (BC) of chronic myeloid leukemia (CML) is usually associated with abnormalities of chromosomes 8, 17, 19, and/or 22 [1]. In most published cases the BC has been of the myeloid type; little is known about the cytogenetic features of lymphatic BC. We report some unusual cytogenetic findings in the lymphatic BC of a CML patient. Chronic myeloid leukemia was diagnosed in a 71-year-old woman. Three years later, she entered the acute phase with 76% blasts in the bone marrow (BM). Peroxidase and a naphthol-acetate-esterase tests were concordant with a lymphoid BC. Chromosome analysis was performed on trypsin-Giemsa-banded preparations from short-term (24 and 48 hours) BM cultures. Twenty-five BM metaphases were analysed. Four af them showed t(9;22)(q34;q11) as the only abnormality. Among the remaining cells, three clones were observed with the following hypodiploid karyotypes: clone 1, 43-45,XX,t(9;22)(q34;q11),t(2;4;19)(:2q14-*2qter::4q11--~4qter: :19p13--~19q13),-7,inv(12)(p13q13); clone 2: 43-45,XX,t(9;22)(q34;q11),t(2;4;19) (:2q14--~2qter::4ql 1-~4qter::19q13--~19q13), - 7,inv(12)(p13q13), + drain; and clone 3, 43 -45,XX,t(9;22)(q34;q11),t(2;4;19)(:2q14--~2qter::4q11--~4qter::19p13--~19q13), + 4, - 7,inv(12)(p13q13), + dmin. A double minute (dmin) chromosome was detected in 12 metaphases (eight from clone 2 and four from clone 3). Figure 1 shows a representative karyotype of clone 2. Two cytogenetic findings are of interest: 1) the presence of monosomy 7, which appears to be associated with lymphoid transformation [1-4], and 2) the finding of a dmin chromosome, rarely described in CML. To our knowledge, only three cases have been reported until now, and all of them were compatible with lymphoid blast crisis [5-71. JUAN CRUZ CIGUDOSA MARIA JOSE CALASANZ ARTURO GULLON ITZIAR EZPELETA FRANCISCO JOSE OYARZABAL
Department of Genetics University of Navarra Pamplona, Spain Department of Hematology Hospital Virgel del Camino Pamplona, Spain
This work was supported by a grant from the Spanish Ministry of Science. The authors thank Professor F. Mitelman for constructive criticism of the manuscript.
133 © 1990 Elsevier SciencePublishingCo.. Inc. 655 Avenueof the Americas,New York,NY 10010
Cancer Genet Cytogenet48:133-134(1990) 0165-4608/90/$03.50
134
1. C. C i g u d o s a et ah
-'i 1
2
3
6
7
8
9
10
4
5
11
12
D
drain
16 13
14
,9
2o
17
18
15
2,
22
X X
F i g u r e 1 Representative karyotype of clone 2, showing the Ph chromosome, the derivative chromosomes 2, 4, 19, monosomy 7, inv(12}, and one drain. Monosomy 21 was not clonal. Structurally rearranged chromosomes (arrow}.
REFERENCES 1. Bernstein R (1988}: Cytogenetics of chronic myelogenous leukemia. Semin Hemato125:20-34. 2. O'Malley FM, Garson OM (1985}: Chronic granulocytic leukemia: Correlation of blastic transformation type with karyotypic evolution. Am J Hematol 20:313-323. 3, Parreira L, Kerany L, Rassol F, Babpu]le VB, Matures E, Parreira A, Tavares de Castro J, Goldman JM, Catovsky D (1986}: Correlation between chromosomal abnormalities and blast phenotype in the blast crisis of Ph'-positive CGL. Cancer Genet Cytogenet 22:29-34. 4. Diez-Martin IL, Dewald GW, Pierre RV (1988): Possible cytogenetic distinction between lymphoid and myeloid blast crisis in chronic granulocytic leukemia. Am J Hematol 27:19-203. 5. Alimena G, Dallapicola B, Gastaldi R, Mandelli F, Brandt L, Mitelman F, Nilsson PG (1982): Chromosomal, morphological and clinical correlations in blast crisis of chronic myeloid leukemia. A study of 69 cases. Scand J Haematol 28:103-117. 6. Uehara M, Kida M, Kamamura M (1987}: Rings and double minutes in a case with blastic phase of chronic myelocytic leukemia. Cancer Genet Cytogenet 25:253-258. 7. Mitelman F (1988): Catalog of Chromosome Aberrations in Cancer, 3rd Ed. Alan R. Liss, New York, p. 988.
