Coexistence of JAK2 or CALR mutation is a rare but clinically important event in chronic myeloid leukemia patients treated with tyrosine kinase inhibitors.

INTRODUCTION: There are 7 designated conditions under the category of myeloproliferative neoplasms (MPN), including chronic myelogenous leukemia (CML) and classical MPN, that is, polycythemia vera (PV), essential thrombocythaemia (ET), and primary myelofibrosis (PMF). Recently, reports about Philadelphia and JAK2 V617F-positive MPN cases have been described in literature. The coexistence of different molecular defects may change the clinical and laboratory manifestation of MPN and may result in an inappropriate interpretation of the response to treatment with tyrosine kinase inhibitors in CML patients. METHODS: The morphological, cytogenetic, and molecular genetic data from a retrospective analysis of 592 adult patients aged 18-86 years diagnosed with CML were analyzed. RESULTS: In 5 CML patients, the presence of JAK2 V617F or CALR mutation was confirmed. Three of 4 TKI-treated patients did not reach complete hematologic response due to the persistence of thrombocytosis and/or splenomegaly. In all of them (in 3 with JAK2 V617F mutation and 1 with CALR mutation), thrombocytosis was present at the time when complete cytogenetic response was documented. In 3 out of 4 reported CML patients, thrombocytosis and/or splenomegaly were still present even at the time when deep molecular response was reached. CONCLUSION: In our opinion, a detailed evaluation and appropriate interpretation of clinical and laboratory data in such a category of patients seem to be extremely important, especially when a decision about the TKI change due to therapy failure is considered.

[Hematologic changes in stomach cancer]. / Zmiany hematologiczne w raku zoladka.

Haematologic disturbances in 13 cases of gastric cancer are described. All the patients had anemia of different origin. Increased leukocytosis was observed in half of the cases, leukemic reaction in one third. Hemolysis was present in 50% of cases. Thrombocytopenia coexisted most frequently with disseminated intravascular coagulation in 4 patients. Bone metastases were visualised as osteolytic foci with radiological methods or increased capture of isotopic marker in the bones under scintigraphic examination. Under the microscope neoplastic metastases were found in bone marrow smears of 5 patients. All patients displayed symptoms of gastric ulcer disease acute or chronic phase. In some cases only repeated gastroscopic examination and mucosa biopsy was the only way to confirm cancer. In other cases the diagnosis was made after the histopathologic examination of the resected stomach, in still others by a section.

[Actinomycosis as a complication of blood diseases]. / Promienica jako powiklanie chorób krwi.

Two cases of actinomycosis in chronic myelogenous leukaemia (CML) and Hodgkin's disease (HD) are presented. The first patient with blastic crisis in CML had painful infiltration above and beneath the clavicular region, affecting the right humeral joint, what required differentiation from neoplastic infiltration. Specific infiltration, formation of fistuli and good response to antibiotic therapy suggested actinomycosis. Finally actinomycosis was diagnosed by microbiological and histopathological examination. The infection with actinomycosis in the other patient interfered with early diagnosis of coexistant Hodgkin's disease. The histopathologic examination of right cervical lymph nodes indicated the chronic inflammatory process. The subsequent histo pathologic examination of the axillary lymph node showed Hodgkin's disease, type LD. Culture from the exudating wound after lymph node excision was positive for actinomyces. Simultaneous treatment with cytostatics and antibiotics resulted in complete recovery of patient. In the above reported patients, actinomycosis complicated the course of CML and HD. The immune deficiency of the organism in both patients facilitated the development of the actinomycosis.

[Haematologic changes in gastritic cancer]. / Zmiany hematologiczne w raku zoladka.

Haematologic disturbances in 13 cases of gastric cancer are described. All the patients had anemia of different origin. Increased leukocytosis was observed in half of the cases, leukaemia reaction in one third. Haemolysis was present in 50% of cases. Thrombocytopenia coexisted most frequently with disseminated intravascular coagulation in 4 patients. Bone metastases were visualised as osteolytic foci with radiological methods or increased capture of isotopic marker in the bones under scintigraphic examination. Under the microscope neoplastic metastases were found in bone marrow smears of 5 patients. All patients displayed symptoms of gastric ulcer disease acute or chronic phase. In some cases only repeated gastroscopic examination and mucosa biopsy was the only way to confirm cancer. In other cases the diagnosis was made after the histopathologic examination of the resected stomach, in still others by a section.