An asymptomatic 61-year-old man with BCR-ABL-positive bone marrow following autologous transplantation for multiple myeloma

Abstract

A 61-year-old man treated with an autologous transplant for multiple myeloma was incidentally found to have a high level of BCR-ABL fusion gene-positive cells in his bone marrow. We describe the clinical decision-making process that led us to initiate therapy with imatinib, despite the absence of any clinical evidence of chronic myelogenous leukemia or other BCR-ABL associated hematologic malignancy.

Figure 1

Bone marrow biopsy (40X, Wright Giemsa stain, 12 months after auto-transplantation for multiple myeloma). The marrow is slightly hypocellular and exhibits trilineage maturation and erythroid predominance; plasma cells are not increased in number.

Figure 2

Detection of the t(9;22) and a BCR-ABL fusion gene. Cytogenetic and FISH analyses performed on a bone marrow aspirate obtained at the time of the biopsy shown in Figure 1 revealed the t(9;22) in metaphase chromosome spreads (A) and the presence of a BCR-ABL fusion gene in interphase nuclei (B). Cytogenetic and FISH analyses revealed the t(9;22) in 15 of 20 metaphases and the presence of a BCR-ABL fusion gene in 20 of 100 interphase cells, respectively.

Figure 3

BCR-ABL fusion transcript levels. Reverse-transcriptase polymerase chain reaction (RT-PCR) was used to detect and quantify the levels of BCR-ABL fusion transcripts, relative to an internal housekeeping control gene (GUS), at various points in the patient’s course.