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Molecular Heterogeneity of Adult Philadelphia Chromosome-positive Acute Lymphoblastic Leukemia¹

Departments of Medicine, Genetics, and Development, and the Comprehensive Cancer Center, Columbia University, New York, New York 10032 [K. S-R., J. G. M., D. L.], and Division of Neoplastic Diseases, New York Medical College, Valhalla, New York 10595 [Z. A., L. G. S.]

The (9;22) translocation which produces the Philadelphia (Ph¹) chromosome activates the abl oncogene from chromosome 9 by recombination with the bcr gene from chromosome 22. This fusion gene is transcribed into a new 8.5-kilobase chimeric mRNA which is translated into a novel M_r 210,000 fusion protein which has a protein tyrosine kinase activity that is greatly increased in comparison to the activity of the normal abl protein. Studies from this laboratory and others have shown that virtually all patients with chronic myelogenous leukemia have this new bcr/abl fusion gene. In contrast to these findings in chronic myelogenous leukemia, a small number of patients with Ph¹(+) acute lymphoblastic leukemia (ALL) have been studied and were found to lack the bcr/abl fusion gene [bcr(-)], but to have a new activation of abl, by recombination with an as yet undetermined region on chromosome 22. In this study, nine adults with Ph¹(+)-ALL have been examined for evidence of a bcr/abl fusion gene. Of the nine patients, five have a bcr/abl recombination, whereas the remaining four patients do not. In contrast, the children studied to date have all been bcr(-). These data suggest that adults with Ph¹(+)-ALL are a more heterogeneous group on a molecular level than are children, and that further studies will be required to determine the spectrum of molecular defects in patients with Ph¹(+)-ALL, and the relationship of these various molecular defects to the clinical disease state of the individuals.

¹ Supported in part by Grants CA37193 (J. G. M.) and CA44028 (D. L.) from the NIH.

² Recipient of a Clinical Investigator Award, CA00968, from the National Cancer Institute. To whom requests for reprints should be addressed, at Columbia University, HHSC 1602, 701 West 168th St., New York, NY 10032.

Received 3/13/87. Revised 8/ 6/87. Revised 11/ 9/87. Accepted 11/16/87.

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