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Megakaryoblastic micromegakaryocytic crisis in chronic myeloid leukemia

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Summary

Atypical megakaryoblasts (MKB) or megakaryocytes (MK) are occasionally present in the peripheral blood during the terminal development of chronic myeloid leukemia (CML). We report on a 49-year-old female suffering from Ph1 chromosome-positive CML with typical megakaryoblastic transformation in the peripheral blood and in the bone marrow. The small “blasts” were at the most only slightly larger and were occasionally even smaller than lymphocytes but showed megakaryoblastic or atypical megakaryocytic differentiation. The cytoplasmic cytochemical pattern of the atypical megakaryocytic cells was identical to that of large atypical thrombocytes. Platelet peroxidase was detected upon electron-microscopic (EM) examination. Immunologic characterization disclosed the presence of MK-specific antigens. When cultured in vitro on agar, the blasts transformed spontaneously into large mature MK, exhibiting characteristic cytochemical and immunological patterns. Cytogenetic examination of peripheral blood showed severe abnormalities. The patient did not respond to therapy and died 3 months after manifestation of the blast crisis.

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References

  1. Bain B, Catovsky D, O'Brien M, Spiers AS, Richards HG (1977) Megakaryoblastic transformation of chronic granulocytic leukemia: an electron microscopy and cytochemical study. J Clin Pathol 30: 235–242

    Google Scholar 

  2. Barka T, Anderson FJ (1962) Histochemical methods for acid phosphatase using hexazonium pararosanilin as a coupler. J Histochem Cytochem 10: 741–748

    Google Scholar 

  3. Breton-Gorius J, Reyes F (1976) Ultrastructure of human bone marrow cell maturation. Int Rev Cytol 46: 252–265

    Google Scholar 

  4. Breton-Gorius J, Reyes F, Vernant JP, Tulliez M, Dreyfus B (1978) The blast crisis of chronic granulocytic leukemia: megakaryoblastic nature of cells as revealed by the presence of platelet peroxidase: a cytochemical ultrastructural study. Br J Haematol 39: 295–303

    Google Scholar 

  5. Castoldi GL, Grusovin GD, Scapoli GL (1975) Consecutive cytochemical staining for the analysis of the blastic population in the acute phase of chronic myeloid leukemia. Biomedicine 23: 12–16

    Google Scholar 

  6. Castro-Malaspina H, Moore MAS (1982) Pathophysiological mechanisms operating in the development of myelofibrosis. Role of megakaryocytes. Nouv Rev Fr Hematol 24: 221–226

    Google Scholar 

  7. Castro-Malaspina H, Rabellino EM, Yen A, Nachman RL, Moore MAS (1981) Human megakaryocyte stimulation of proliferation of bone marrow fibroblasts. Blood 57: 781–787

    Google Scholar 

  8. Den Ottolander GJ, Te Velde J, Brederoo P, Geraedts JPM, Slee PHT, Willemze SR, Zwaan FE, Haak HL, Muller P, Bieger R (1979) Megakaryoblastic leukemia (acute myelofibrosis): a report of three cases. Br J Haematol 42: 9–20

    Google Scholar 

  9. El Mohandes E, Hayhoe FGJ (1983) 5-nucleotidase activity of megakaryoblasts in a case of acute megakaryoblastic leukemia. Br J Haematol 53: 523–526

    Google Scholar 

  10. Fialkow PJ, Denman AM, Jacobson RJ, Lowenthal MN (1978) Chronic myelocytic leukemia: origin of some lymphocytes from leukemic stem cells. J Clin Invest 62: 815–823

    Google Scholar 

  11. Fialkow PJ, Jacobson RJ, Papayannopoulou T (1977) Chronic myelocytic leukemia: clonal origin in a stem cell common to the granulocyte, erythrocyte platelet and monocyte/macrophage. Am J Med 63: 125–129

    Google Scholar 

  12. Flandrin G, Daniel MT, Valensi F, Schaison G, Breton-Gorius J (1977) Leucémie aigue à megacaryoblastes. Etude clinique et morphologique de 11 observations. Actual Hematol 11: 200–214

    Google Scholar 

  13. Franzen S, Strenger G, Zajicek J (1981) Mikroplanimetric studies on megakaryocytes in chronic granulocytic leukemia and polycythemia vera. Acta Haematol 26: 182–189

    Google Scholar 

  14. Geissler D, Konwalinka G, Peschel C, Boyd J, Odavic R, Braunsteiner H (1983) Clonal growth of human megakaryocytic progenitor cells in a micro-agar culture system: Simultaneous proliferation of megakaryocytic, granulocytic and erythroid progenitor cells (CFU-M, CFU-C, BFU-E) and T-lymphocytic colonies (CFU-TL). Intern J Cell Clon 1: 377–388

    Google Scholar 

  15. Hayhoe FGJ, Quaglino D (1980) Haematological Cytochemistry. Churchill Livingstone, Edinburgh

    Google Scholar 

  16. Hemmler G (1948) Leucémie mégacaryocytaire avec thrombocythémie. J Suisse Med 78: 976–981

    Google Scholar 

  17. Hossfeld DK, Tormey D, Ellison RR (1975) Ph'-positive megakaryoblastic leukemia. Cancer 36: 576–581

    Google Scholar 

  18. Huhn D, Ascher S (1975) Mikrokaryoblastenschub bei chronischer Myelose. Acta Haematol 53: 183–190

    Google Scholar 

  19. Jacobson RJ, Salo A, Fialkow PJ (1978) Agnogenic myeloid metaplasia: a clonal proliferation of hematopoietic stem cells with secondary myelofibrosis. Blood 51: 189–194

    Google Scholar 

  20. Kaplow LS (1955) A histochemical procedure for localizing and evaluating leukocyte alkaline phosphatase activity of blood and bone marrow. Blood 10: 1023–1034

    Google Scholar 

  21. Lorbacher P, Yam LT, Mitus WJ (1967) Cytochemical demonstration of β-glucuronidase activity in blood and bone marrow cells. J Histochem Cytochem 15: 680–688

    Google Scholar 

  22. Mähr, G, Rindler R, Schmalzl F (1973) Zur Spezifität des Glykogennachweises in Leukozyten, Leber und quergestreiftem Muskel. Glykogenhydrolyse durch alpha-1,6-Amylo-glukosidase. Klin Wochenschr 51: 570–580

    Google Scholar 

  23. Marie JP, Vernant JP, Dreyfus B, Breton-Gorius J (1979) Ultrastructural localisation of peroxidases in undifferentiated blasts during the blast crisis of chronic granulocytic leukemia. Br J Haematol 43: 549–558

    Google Scholar 

  24. Marchal G, Duhamel G (1954) La leucémie à megacaryocytes (à propos de 5 observations). Sem Hop Paris 15: 887–892

    Google Scholar 

  25. Mazur EM, Hoffman R, Chasis J, Marchesi S, Bruno E (1981) Immunofluorescent identification of human megakaryocyte colonies using an anti-platelet glycoprotein anti-serum. Blood 57: 277–288

    Google Scholar 

  26. Mehta AB, Baughan AS, Catovsky D, Goldmann JM, Johnson SA, Galton DAG (1983) Reversal of marrow fibrosis in acute megakaryoblastic leukemia after remission-induction and consolidation chemotherapy followed by bone marrow transplantation. Bri J Haematol 53: 445–450

    Google Scholar 

  27. Minot GR (1922) Megakaryocytes in the peripheral circulation. J Exp Med 36: 1–12

    Google Scholar 

  28. Moloney WC, McPherson K, Fliegelman L (1960) Esterase activity in leukocytes demonstrated by the use of naphthol-AS-D-chloroacetate substrate. J Histochem Cytochem 8: 200–207

    Google Scholar 

  29. Ogawa M, Fried J, Sakai Y, Strife A, Clarkson BD (1970) Studies of cellular proliferation in human leukemia. VI. The proliverative activity, generation time, and emergence time of neutrophilic granulocytes in chronic granulocytic leukemia. Cancer 25: 1031–1049

    Google Scholar 

  30. Olah E, Rak K (1981) Prognostic value of chromosomal findings in the blast phase of Ph'-positive chronic myeloid leukmia. Cancer 27: 287–295

    Google Scholar 

  31. Peterson LC, Bloomfeld CD, Brunning RD (1976) Blast crisis as an initial or terminal manifestation of chronic myeloid leukemia. A study of 28 patients. Am J Med 60: 209–220

    Google Scholar 

  32. Prigogina EL, Fleischman EW, Volkowa MA, Frenkel MA (1978) Chromosome abnormalities and clinical and morphological manifestations of chronic myeloid leukemia. Hum Genet 41: 143–156

    Google Scholar 

  33. Rabellino EM, Nachman RL, Williams N, Winchester RJ, Ross GD (1979) Human megakaryocytes. I. Characterization of the membrane and cytoplasmic components of isolated marrow megakaryocytes. J Exp Med 147: 1273–1281

    Google Scholar 

  34. Rabellino EM, Levene RB, Leung LLK, Nachman RL (1981) Human megakaryocytes. II. Expression of platelet proteins in early marrow megakaryocytes. J Exp Med 154: 88–95

    Google Scholar 

  35. Rosenthal S, Canellos GP, DeVita VT, Gralnick HR (1977) Characteristics of blast crisis in chronic granulocytic leukemia. Blood 49: 705–714

    Google Scholar 

  36. Schaefer HE, Fischer R (1968) Der Peroxidasenachweis an Ausstrichpräparaten sowie an Gewebsschnitten nach Entkalkung Paraffineinbettung. Klin Wochenschr 46: 1228–1235

    Google Scholar 

  37. Schmalzl F, Braunsteiner H (1968) Cytochemische Darstellung von Esteraseaktivitäten in Blut- und Knochenmarkszellen. Klin Wochenschr 46: 642–653

    Google Scholar 

  38. Sonta S, Sandberg AA (1978) Chromosomes and causation of human cancer and leukemia. XXIX. Further studies an karyotypic progression in CML. Cancer 41: 153–164

    Google Scholar 

  39. Tabilio A, Vainchenker W, Van Haecke D, Vinci G, Deschamps JF, Guichard J, Henri A, Xu FS, Reyes F, Breton-Gorius J (1984) Immunological characterization of the leukemic megakaryocytic line at light and electron microscopic levels. Leuk Res 8: 769–781

    Google Scholar 

  40. Though IM, Jacobs PA, Court Brown WM, Beikei AG, Williamson ERD (1963) Cytogenetic studies on bone marrow in chronic myeloid leukemia. Lancet 1: 844–846

    Google Scholar 

  41. Undritz E, Nusselt-Bohaumilitzky K (1968) Über das Auftreten diploider Megakaryoblasten, Promegakaryozyten und Megakaryozyten bei schweren Hämopathien: ein Rückgriff in die Phylogenese. Schweiz Med Wochenschr 98: 1686–1687

    Google Scholar 

  42. Vainchenker W, Deschamps JF, Bastin JM, Guichard J, Titeux M, Breton-Gorius J, McMichael A (1982) Two monoclonal antiplatelet antibodies as markers of human megakaryocyte maturation: immunofluorescent staining and platelet peroxidase detection in megakaryocytic colonies and in vivo cells from normal and leukemic patients. Blood 59: 514–522

    Google Scholar 

  43. Whang-Peng J, Canellos GP, Carbone PP, Tjio JH (1968) Clinical implication of cytogenetic variants in chronic myeloid leukemia (CML). Blood 32: 755–766

    Google Scholar 

  44. Williams WC, Weiss GB (1982) Megakaryoblastic transformation of chronic myelogenous leukemia. Cancer 49: 921–926

    Google Scholar 

  45. Yam LT, Li CY, Crosby WH (1971) Cytochemical identification of monocytes and granulocytes. Am J Clin Pathol 55: 283–290

    Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, University of Innsbruck, Austria

    G. Lingg, F. Schmalzl, D. Geissler & W. Kirchmair

  2. Unité de Recherche sur les Anémies de l'Inserm, Créteil, France

    J. Breton-Gorius & A. Tabilio

  3. Department of Pathology, University of Freiburg i Br, FRG

    H. E. Schaefer

  4. Institute of Medical Biology and Genetics, University of Innsbruck, Austria

    M. Schweiger

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  1. G. Lingg
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  2. F. Schmalzl
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  3. J. Breton-Gorius
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  4. A. Tabilio
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  5. H. E. Schaefer
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  6. D. Geissler
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  7. M. Schweiger
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  8. W. Kirchmair
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Lingg, G., Schmalzl, F., Breton-Gorius, J. et al. Megakaryoblastic micromegakaryocytic crisis in chronic myeloid leukemia. Blut 51, 275–285 (1985). https://doi.org/10.1007/BF00320522

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  • DOI: https://doi.org/10.1007/BF00320522

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