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The spectrum of adult B‐lymphoid leukemias with BCR‐ABL: Molecular diagnostic, cytogenetic, and clinical laboratory perspectives
Author(s) -
Klco Jeffery M.,
Kreisel Friederike H.,
Zehnbauer Barbara A.,
Kulkarni Shashikant,
Hassan Anjum,
Frater John L.
Publication year - 2008
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.21291
Subject(s) - philadelphia chromosome , chronic myelogenous leukemia , chromosomal translocation , breakpoint cluster region , bone marrow , abl , medicine , leukemia , immunology , chromosome abnormality , cytogenetics , acute lymphocytic leukemia , lymphoblastic leukemia , cancer research , biology , chromosome , oncology , karyotype , genetics , receptor , tyrosine kinase , gene
The Philadelphia (Ph) chromosome is characteristic of chronic myelogenous leukemia (CML), but it is also the most frequent cytogenetic abnormality in precursor B‐lymphoblastic leukemia (ALL) of adults. The vast majority of CML patients have a BCR‐ABL translocation that yields a 210 kD (p210) oncoprotein, whereas adult Ph‐positive ALL cases can present with either a p190 or a p210 oncoprotein, or both. Considering that 30% of the patients with CML that progress to blast crisis will have a lymphoblastic presentation, adults presenting with a p210 ALL may have either a de novo ALL or CML presenting for the first time in lymphoblastic phase. To identify the distinguishing features, cases of p190‐ALL, p210‐ALL, and lymphoblastic CML were compared. In spite of significant overlap between the three entities, a number of features were found to aid in their differentiation. p210‐ALL patients present at a younger age with blasts that frequently show loss of expression of CD34, whereas p190‐ALL patients present with marked increase in peripheral blast percentage. Interestingly, bone marrow findings characteristic of a myeloproliferative disorder are specific, but are not sensitive for lymphoblastic CML. This study suggests that despite the similarities between these leukemias, p190‐ALL, p210‐ALL, and lymphoblastic phase CML likely represent three distinct diseases. Am. J. Hematol., 2008. © 2008 Wiley‐Liss, Inc.