Ultrastructural, cytochemical and surface marker analysis of cells during blast crisis of chronic granulocytic...

The blast cells of 19 patients with Ph1-positive chronic granulocytic leukaemia (CGL) in blast crisis (BC) were studied by means of several techniques: morphology, cytochemistry, ultrastructure, surface markers and the enzyme terminal transferase. Cells of BC were, in most case, extremely undifferentiated by morphology and cytochemistry. Our data showed that in 80% of cases the cells in BC were myeloid and in 20% they were "lymphoblastic". The M1, M2 and M3 forms (FAB classification) were rare in CGL BC compared with acute myeloid leukaemia (AML). A megakaryoblastic type was seen in 15% of BC cases; the existence of this form could only be demonstrated by electron microscopy. The limphoblastic BC cells were, as in acute lymphoblastic leukaemia (ALL), positive with Greaves' anti-ALL serum and had elevated levels of terminal transferase. A case of a 17-year old boy presenting as ALL, reverting to chronic-phase CGL after complete remission and developing terminally a myeloid BC is described in detail. This case helps to illustrate a new form of natural history of CGL unveiled by the present study.