DETECTION OF MAJOR AND MINOR BCR/ABL FUSION GENE TRANSCRIPTS IN A PATIENT WITH ACUTE UNDIFFERENTIATED LEUKEMIA SECONDARY TO TREATMENT WITH AN ALKYLATING AGENT

In this paper we describe a patient with bcr/abl positive acute undifferentiated leukemia (AUL) derived from acquired sideroblastic anemia secondary to ifosphamide treatment given for the preceding non-Hodgkin lymphoma of the lung. Cytogenetically, Philadelphia chromosome was not detected through the whole course in this patient, and multiple chromosomal abnormalities including 5q(-) and monosomy 7 were found at the stage of sideroblastic anemia. The reverse transcriptase-polymerase chain reaction (RT-PCR) analysis showed no bcr/abl fusion transcript at the diagnosis of malignant lymphoma. The mRNA encoding the major bcr/abl fusion protein then appeared in the stage of sideroblastic anemia. Finally, the mRNA encoding both major and minor bcr/abl was detected in the stage of AUL transformation. MLL gene rearrangement was not found by RT-PCR analysis at any stage of the disorder. These results may be direct evidence for the induction of the bcr/abl fusion gene by treatment with an alkylating agent (ifosphamide).