ACUTE-LEUKEMIA WITH T(1-3)(P36-Q21), EVOLUTION TO T(1-3)(P36-Q21),T(14-17)(Q32-Q21), AND LOSS OF RED-CELL A AND LEB ANTIGENS

At transformation of refractory anemia with ring sideroblasts to acute nonlymphocytic leukemia [ANLL] the bone marrow cells of a 75-year-old woman showed three different karyotypes, i.e., 46,XX, 46,XX,t[1;3][p36;q21] and 46,XX,t[1;3][p36;q21],t[14;17][q32;q21]. She received no antileukemic therapy, and 1 year later, all her bone marrow cells were t[1;3][p36;q21],t[14;17][q32;q21]. In association with the onset and first 11 months of ANLL, the platelet count increased 10-fold to a peak of 750 x 10(9)/L, providing further evidence that the t[1;3][p36;q21] translocation causes stimulation of thrombopoiesis. Six months after transformation, her red cells showed reduced expression of A and Le(b) antigens. Serum alpha-n-3-acetylgalactosaminyl transferase [blood group A transferase] and red cell adenylate kinase were both reduced. The genes for both these substances are at 9q34, which suggests an abnormality here, although cytogenetically chromosome 9 appeared normal. This is the first case with t[1;3][p36;q21] to show concurrent loss of red cell antigens and the first report detailing the course of untreated ANLL with t[1;3][p36;q21].