The spectrum of adult B-lymphoid leukemias with BCR-ABL: Molecular diagnostic, cytogenetic, and clinical laboratory perspectives

Jeffery M. Klco, Friederike H. Kreisel, Barbara A. Zehnbauer, Shashikant Kulkarni, Anjum Hassan, John L. Frater

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)901-907
Number of pages7
JournalAmerican journal of hematology
Volume83
Issue number12
DOIs
StatePublished - Dec 1 2008

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