5 76 Correspondence patients naive to blood product administration, preferably in REFERENCE areas with a low incidence of hepatitis €3.

preliminary results from an ongoing conducted with that objective have shown no further cases of hepatitis B among eight non-vaccinated patients following the adminis-

Tabor, E.. Aronson. D.L. & Gerety. R.J. (1980) Removal of hepatitis B- virus infectivity from factor lX complex by hepatitis B immunoglo- bulin. Lancet, ii, 68-70.

tration of eight lots of vapour heated factor concentrates.

lmmuno AG, A-1 220 Vienna, Austria

JOHANN EIBL GERALD EDER KLAUS ANDERLE

Ph’ CHROMOSOME POSITIVE ACUTE MYELOMONOCYTIC LEUKAEMIA WITH INVERTED CHROMOSOME 1 6

Certain specific chromosomal changes are uniquely asso- ciated with specific subtypes of leukaemia. Inv( 16)(pl3q22) and t(l6;16)(pl3;q22), found in 5% of acute myeloid leukaemias, are associated with myelomonocytic cytology and abnormal eosinophils (M4Eo). The subtle cytogenetic changes were generally mislabelled as ‘16p+’ or ‘normal’ before they were 6rst correctly recognized in 1983 (Le Beau et al, 1983; De La Chapelle & Lahtiien, 1983). We reported a case of Ph’ chromosome positive acute myelomonocytic leukaemia with 16p+ anomaly in 1981 (Li et al, 1981), but have recently re-examined the cytogenetics and cytology of this case and now write to correct our earlier report. Our present interpretation of this patient’s karyotype is: 46XY(9%)/47XY,- 18,+22, inv(l6*) (pl3q22). del (20*) (p12pl3).de1(20*)(q12ql3),t(9;22)(q34;ql l),der( 16*)t( 16; ?18) (q24;q21),+mar(91%) (the asterisks indicate the same homologous chromosomes). Examples of chromosomes 9.22 and 16 are shown in Fig 1.

Consistent with the presence of inv(l6) were the easily induced (after one course of DAT both at diagnosis and at the first relapse) and long-lasting remissions (27 and 10 months for the two remissions respectively), myelomonocytic cyto-

a

b

Fig 1. (a) Chromosomes 9. 22 and 16 from the same cell. (b) Three pairs of chromosomes 16 with the inverted ones on the right.

morphology, conspicuous abnormal eosinophils with mixed eosinophilic and basophilic granules in the bone marrow at diagnosis and the additional chromosomal abnormality + 22. Following remission induction the abnormal eosino- phils disappeared and were not again found in any of 19 subsequent bone marrow aspirates taken during the course of his disease. As pointed out previously (Li et ul, 1981) the absence of obvious features of chronic myeloid leukaemia (CML) through the whole course of the disease favours the diagnosis of primary acute leukaemia. This is further sup- ported by the absence of basophils from peripheral blood and bone marrow throughout the disease.

A similar patient with Ph’ chromosome and inv( 16) was reported recently by Mecucci et aI (1988). Their patient had both basophilia and eosinophilia and failed to respond to chemotherapy. Thus, the possibility of CML presenting in acute phase of a M4Eo cell type could not be ruled out (Mecucci et al, 1988).

Department ofHuematologicu1 Medicine, YOU-SHENG LI University Clinical School. F. G. J. HAYHOE Hills Road Cambridge CB2 2QL

REFERENCES

De La Chapelle, A. & Lahtinen. R. (1 983) Chromosome 16 and bone marrow eosinophilia. New EnglandJournal ofMedicine. 309,1394.

Le Beau, M.M.. Larson, R.A., Bitter, M.A., Vardiman, J.W., Golomb, H.M. & Rowley, J.D. (1983) Association of an inversion of chromosome 16 with abnormal marrow eosinophils in acute myelomonocytic leukemia: a unique cytogenetic-chicopathologi- cal association. New England Journal of Medicine, 309, 630-636.

Li. Y.S.. Khalid. G.. Flemans, R.J. & Hayhoe. F.G.J. (1981) A case of acute myelomonocytic leukaemia with Philadelphia and small F group chromosomes. British Journal ofHaernatology. 48. 175-1 76.

Mecucci, C., Neens. L., Aventin. A., Testoni, N. & Van den Berghe. H. (1988) Philadelphia-positive acute myelomonocytic leukemia with inversion of chromosome 16 and eosinobasophils. American Journal of Hematology. 27, 69-71.