1981 Volume 22 Issue 9 Pages 1454-1462
A case of Ph1-positive ALL in a t (13q 14q) carrier is reported. A 34-year-old woman was admitted to the Nihon University Hospital complaining of high fever, palpitation, chest pain and generalized lymphadenopathy on August 17, 1979. Hematological examination on admission revealed that the WBC count was 211,000/μl with 97.5% blast cells, and the nucleated cell count in the bone marrow was 880,000/μl with 97.8% blast cells. A diagnosis of ALL (L2 by the FAB classification) was made. The blast cells had high TdT activity but had neither T nor B markers. At the time of diagnosis, she had no hepatosplenomegaly. Blood examination showed normal NAP score and no increase in basophils. The level of vitamin B12 in serum was more than 3,200pg/ml. However, a complete remission could not be achieved with either BH-AC·DMP or LVP; the latter combination therapy induced partial remission. In spite of vigorous chemotherapy and supporting therapy, she died of pulmonary bleeding in January 1980.
On admission, cytogenetic analysis of the bone marrow cells revealed a karyotype of 44, XX, -8, -13, -14, +t (13q 14q), t (9q+; 22q-) in 100% (25/25) of mitoses. Peripheral lymphocytes and skin fibroblasts of the patient showed a karyotype of 45, XX, -13, -14, +t (13q 14q). When the patient was in partial remission in October 1979, Ph1 chromosome could not be found out in any of 25 mitoses of her bone marrow cells, but t (13q 14q) still existed in them. From these clinical and laboratory findings, this case was diagnosed as Ph1-positive ALL in a t (13q 14q) carrier.
The coincidence of Ph1 chromosome and t (13q 14q) is discussed in this paper.
