We report two patients with acute leukemias who expressed two types of bcr/ αbl mRNA. The first case was an 8-year-old boy with acute mixed leukemia in whom the Ph1 chromosome and p210/p190 types of bcr/αbl mRNAs were detected at diagnosis. The second case was a 39-year-old male with acute non-lymphocytic leukemia transformed from myelodysplastic syndrome (refractory anemia with excess of blasts). In the latter case, the p210-type mRNA appeared after leukemic transformation, and the p190-type transcript was detected only during the late stage when the Ph1 chromosome was first observed. The leukemias in these two patients were aggressive in their clinical courses. We conclude that the dual expression of p210 and p190 types of bcr/ αbl is a factor indicating a poor prognosis, and that, in some patients, p190-type bcr/αbl may contribute to disease progression.
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