Cytological types of mitoses and chromosome abnormalities in acute leukemia

In order to determine the nature of the cells in mitosis in acute leukemia, a parallel study was conducted by cytological and cytogenetic methods on the same marrow and blood samples. On direct marrow examination, erythrocyte precursors in mitosis are usually observed but ordinarily disappear following in vitro culture. In APL (M3) characterized by t(15;17) translocation, the comparison between the proportions of the different categories of cells in mitosis and of karyotypically normal and abnormal cells suggests that erythroblasts do not belong to the leukemic clone. An analogous situation is observed in AML (M2) with t(8;21) and in monocytic leukemia (M5) with chromosome abnormalities. Erythroleukemia could be divided into two categories, one with chromosome abnormalities and persistence of erythroblast mitoses after culture, and another with no detectable chromosome abnormality and with disappearance of erythroblast mitoses following culture. Other examples of blood malignancies demonstrate the importance of the method used in determining which cell categories belong to the leukemic clone. An interpretation of the results in terms of commitment 'level' of the involved stem cells and a distinction between 'primary' and 'secondary' chromosome abnormalities is proposed.