A patient with acute leukemia and tetraploid blast cells in the bone marrow is reported. The patient was a 69-yr-old white male who was referred to our institution for chemotherapy. His bone marrow contained 89% blasts, 30% of which were peroxidase positive. The clinical history was characterized by a rapid, downhill course, and the patient expired 1 mo after admission in spite of chemotherapy. At autopsy, nests of viable leukemic cells were still present in the bone marrow. Cytogenetic studies demonstrated a true tetraploid karyotype with 92 chromosomes. The various mechanisms that may lead to the establishment of a tetraploid clone and the clinical implications of the presence of these cells in acute leukemia are discussed. So far as we know, this is the first case in which a true tetraploid clone associated with human neoplasia has been identified.

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