[An elderly patient with Ph1-positive chronic myelomonocytic leukemia]

An 80-year-old man with leukocytosis was admitted to our hospital on February 20, 1995. There were no blasts in the peripheral blood, but leukocytosis, associated with marked monocytosis, anemia, and thrombocytopenia was observed. The bone marrow was hyperplastic and there was a slight decrease in megakaryocytes. The myelogram showed 5.6% blasts + promyelocytes, and there was no basophilia. Mild dysplasia of third-line cells was observed. Chromosome analysis yielded 47, XY, +8, t (9;22) (q34;q11), and the Philadelphia (Ph1) chromosome and trisomy 8 were detected. Fluorescence in-situ hybridization revealed a large ber. Because the French-American-British (FAB) cooperative group diagnostic criteria for chronic myelomonocytic leukemia (CMMoL) were fulfilled and the Ph1 chromosome was detected, a diagnosis of Ph1-positive CMMoL was made. Hydroxyurea was given for cytoreduction and the patient has been followed with no evidence of acute transformation for about one year. CMMoL is classified as a myelodysplastic syndrome. However, it is rare to find the Ph1 chromosome in patients with these syndromes, and there have been very few reports of its detection in CMMoL. CMMoL may not be a single disease entity, and it may be useful to investigate more cases like the present one, to reassess this disease.