DRUG-RESISTANCE OF SECONDARY ACUTE MYELOID-LEUKEMIA WITH MEGAKARYOBLASTIC FEATURES AND P190 BCR-ABL REARRANGEMENT

A 46-year-old female presented with acute myeloid leukemia during comp lete remission of multiple myeloma after extensive treatment with alky lating agents. Leukemic blasts expressed CD34, platelet esterase and g p IIIa. RT-PCR analyses of peripheral blood cells detected a p190 type BCR-ABL rearrangement and high levels of MDR1. The patient expired du ring neutropenia shortly after induction chemotherapy. Autopsy reveale d persistent blasts in the bone marrow, spleen and liver. 'Secondary' acute myeloid leukemia with megakaryoblastic features and p190-type BC R-ABL rearrangement has not previously been reported. The possibility that the combination of a BCR-ABL rearrangement with overexpression of MDR1 may have contributed to the treatment-refractory course is discu ssed. (C) 1998 Elsevier Science Ltd. All rights reserved.