Chronic myelocytic leukemia with two Philadelphia chromosomes and prominent peripheral lymphadenopathy.

By CHARLES P. DUVALL, PAUL P. CARBONE, WILLIAM R. BELL, JACQUEUNE WILANG, J. H. TJI0 AND SEYMOUR PERRY A MINOR DEGREE OF LYMPHADENOPATHY occurs in relatively few cases of patients with chronic myelocytic leukemia ( CML ).‘ Marked lymph node enlargement may occur late in the course of the disease, usually with the development of the myeloblast crisis, and may be considered a poor prognostic sign.2’3 Rarely, the clinical and histopathologic picture can mimic lymphoma.4 Recently, Kiossoglou, Mitus and Dameshek reported a patient with “significant” lymphadenopathy with hvo Philadelphia (Ph’ ) chromosomes.5 In reports of cytogenetic studies in CML there is no mention made of lymphadenopathy of marked degree in those patients with 2 Ph1 chromosomes.68 Three adult patients with chronic myelocytic leukemia, marked peripheral lymphadenopathy, and two Ph1 chromosomes are described in this report. It is noteworthy that all 3 patients had the double Ph’ chromosome in cytogenetic preparations and 2 of the 3 had significant adenopathy before blastic crisis occurred.