[Secondary leukemia (AML) with TcR beta rearrangement]

A 60-year-old female with fever and general lymphadenopathy was admitted to our hospital in 1979. By histological examination of cervical lymph node, she was diagnosed as B-cell malignant lymphoma, diffuse, large, stage IV B (Ann Arbor classification). In 1984, the complete remission of malignant lymphoma was observed after MOPP, COPP and VAPP chemotherapies. After 3 years, she was readmitted because of leukocytosis in which 64% immature abnormal cells were detected. By conventional cytological and cytochemical evaluations, the immature abnormal cells were identified as secondary AML cells with M 2 type (FAB), peroxidase (+), My 7 (+) and chromosomal abnormality; 48, X, -X, +4, -9, +21, del (1) (p 34), i (17 q), + M 1, + M 2. Analysis of Ig and TcR genes showed TcR-beta rearrangement. It has been reported that secondary leukemia frequently causes chromosomal abnormalities and therapy resistance. Ig gene and TcR gene analysis of secondary leukemia combined with chromosome examination, which has reported little, may be useful in predicting prognosis and therapy resistance.