Supernumerary Philadelphia Positive

Philadelphia chromosome is observed in 25-50% of adult Acute Lymphoblastic Leukemia (ALL) cases and in about 5% of childhood ALL cases. A hyper diploid karyotype, defined by the presence of more than 46 chromosomes, is detected in 2-9% of adult ALL patients and in 29% of pediatric patients [1]. Translocation t (9; 22) or Philadelphia chromosome is a common structural aberration found in patients, who present with hyper diploidy [2,3]. It is conceivable that the simultaneous presence of additional karyotypic abnormalities may alter the biological properties of Ph+ cells and influence clinical outcomes [4]. In this context, the coexistence of a high-hyper diploid (53 chromosomes) karyotype with double Ph+ chromosomes is of interest since high-hyper diploidy as the sole cytogenetic abnormality in ALL is associated with a good prognosis [4], while Philadelphia positivity confers a worse prognosis.