Eradication of the intramedullary Ph1 positive cell line without accompanying improved survival in chronic myelogenous leukemia.

A patient with Ph1+ chronic myelogenous leukemia is presented who upon entering the accelerated phase of her disease developed aneuoploidy, including duplication of the Philadelphia chromosome. Intensive chemotherapy resulted in a marrow remission and reversion of the marrow karyotype to normal. Rather than entering an anticipated prolonged remission she relapsed four weeks later with return of her aneuploid clone. Postmortem examination revealed several unsuspected areas of extramedullary leukemia, perhaps serving as the source for repopulation of the marrow. If a desired goal of therapy is to eradicate the Ph1+ cell line, then we recommend that it be undertaken early in the disease when there is the least likelihood of extramedullary leukemia.