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Acute myelomonocytic leukemia with abnormal eosinophils and inv(16) or
t(16;16) has a favorable prognosis
RA Larson, SF Williams, MM Le Beau, MA Bitter, JW Vardiman and JD Rowley
Inv(16)(p13q22) and t(16;16)(p13;q22) are recurring chromosomal
rearrangements which juxtapose the metallothionein gene cluster at 16q22
with other DNA sequences from 16p13. We have studied 20 men and 13 women
who had acute nonlymphocytic leukemia; 27 patients had an inv(16) and six
patients had a t(16;16). Eight patients also had trisomy 22, and four had
trisomy 8. All but two patients had the unique morphologic features of
acute myelomonocytic leukemia with abnormal eosinophils (M4Eo). In one
patient with M4 leukemia, abnormal eosinophils were not observed in the
marrow. A second patient had acute monocytic leukemia, plus abnormal
eosinophils. Eosinophils constituted 1% to 46% (median, 6%) of the bone
marrow cells, and in all but a single patient, the eosinophils exhibited
distinctly abnormal morphology. Twenty-five patients have had a complete
remission (78% of treated patients). Nine patients have remained in
remission longer than 24 months. No patient had symptoms of central nervous
system (CNS) disease at diagnosis, and none had CNS leukemic mass lesions
at any time. Treatment with high-dose cytarabine may have provided
prophylactic CNS therapy. Four additional patients with chromosomal
rearrangements involving a breakpoint at 16q22 but not at 16p13 have had
different morphological features and different clinical courses. Thus, the
juxtaposition of genes at 16p13 and 16q22, which occurs both in the inv(16)
and the t(16;16), results in a specific subset of acute nonlymphocytic
leukemia that has a favorable prognosis.
Volume 68,
Issue 6,
pp. 1242-1249,
12/01/1986
Copyright © 1986 by The American Society of Hematology
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