Here we report an unusual case of Chronic Myelogeneous Leukemia (CML) developing towards an Acute Myelogeneous Leukemia subtype M5 (AML-M5). The chromosomal constitution was at (final) stage of AML-M5: Philadelphia chromosome positivity with multiple trisomies, a double t (9; 22) (q34; q11) and an AML1/MDS1/EVI1 (AME) fusion transcript resulting from a t (3; 21) (q26; q22). The latter translocation was detectable first in blast phase of CML and remained present in AML-M5 stage. Overall, four chromosomal analyses were done within 19 months, describing the ongoing karyotypic evolution during this transformation. Unfortunately this exceptional patient did not respond to Imatinib-(IM) or Nilotinib-therapy. These finding May by a first hint that CML-patients acquiring a t (3; 21) (q26; q22) might be appropriate to bone marrow transplantation rather than for IM-therapy.including a double t (9; 22) (q34; q11) and an AME fusion transcript resulting from a t(3;21)(q26;q22).
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