Spencer A, Vulliamy T, Chase A, Goldman J M
LRF Adult Leukaemia Centre, Royal Postgraduate Medical School, London, UK.
Leukemia. 1995 Dec;9(12):2138-9.
A 23-year-old male found to have Philadelphia chromosome-positive chronic myeloid leukemia (CML) in May 1987 suffered a myeloid blastic transformation in April 1993. A second chronic phase was achieved after treatment with daunorubicin and cytosine arabinoside and the patient then underwent autologous bone marrow transplantation (ABMT) using previously cryopreserved chronic phase bone marrow. Examination of his marrow during the second chronic phase revealed a double Philadelphia chromosome in 15% of metaphases examined and in rearrangement of the immunoglobulin heavy chain gene joining region using Southern blot analysis. Following transplantation, his marrow regenerated into lymphoid blast crisis with three distinct immunoglobulin gene rearrangements visible, one of which corresponded in size to the detected rearrangement pre-transplant. This case is consistent with myeloid to lymphoid clonal succession underlying recurrent blast crises in a patient with CML and suggests the co-existence of both clones prior to ABMT.
一名23岁男性于1987年5月被诊断为费城染色体阳性慢性髓性白血病（CML），1993年4月发生髓系原始细胞转化。经柔红霉素和阿糖胞苷治疗后进入第二个慢性期，随后患者使用先前冻存的慢性期骨髓进行了自体骨髓移植（ABMT）。在第二个慢性期对其骨髓进行检查时，在15%的中期分裂相中发现了双费城染色体，并通过Southern印迹分析发现免疫球蛋白重链基因连接区发生重排。移植后，其骨髓再生为淋巴母细胞危象，可见三种不同的免疫球蛋白基因重排，其中一种在大小上与移植前检测到的重排相对应。该病例符合CML患者复发性原始细胞危象背后的髓系到淋巴系克隆演替，并提示在ABMT之前两种克隆共存。
