Figure 1
Figure 1. Diagnosis and clinical course of patient 1. (A) FISH with whole-chromosome painting probes for chromosomes 9 (yellow), 12 (green), and 13 (red) demonstrating the 12;13 translocation and involvement of the derivative chromosome 12 in an additional translocation with chromosome 9 (left). FISH analysis confirmed involvement of ETV6, showing the 5′-ETV6 probe labeled in red on the derivative chromosome 13 and the 3′-ETV6 probe labeled in green on the derivative chromosome 12 in patient 1 at diagnosis (right). Cytogenetic and FISH analyses with break-apart probes for the detection of ETV6 rearrangements (Abbott) were performed according to standard procedures.14,15 (B) Bone marrow morphology of patient 1 at diagnosis of sunitinib-resistant blast phase/secondary acute myeloid leukemia 6 months after start of sunitinib (left) and 5 weeks after initiation of sorafenib (right). Micrographs were taken by an Axiolmager M1 (Zeiss) using an EC Plan-Neofluar, 100×/1.3 oil, 0.17 objective lens (Zeiss). (C) Hematologic response to treatment with sunitinib and sorafenib in patient 1 over a 250-day period. AML indicates acute myeloid leukemia.

Diagnosis and clinical course of patient 1. (A) FISH with whole-chromosome painting probes for chromosomes 9 (yellow), 12 (green), and 13 (red) demonstrating the 12;13 translocation and involvement of the derivative chromosome 12 in an additional translocation with chromosome 9 (left). FISH analysis confirmed involvement of ETV6, showing the 5′-ETV6 probe labeled in red on the derivative chromosome 13 and the 3′-ETV6 probe labeled in green on the derivative chromosome 12 in patient 1 at diagnosis (right). Cytogenetic and FISH analyses with break-apart probes for the detection of ETV6 rearrangements (Abbott) were performed according to standard procedures.14,15  (B) Bone marrow morphology of patient 1 at diagnosis of sunitinib-resistant blast phase/secondary acute myeloid leukemia 6 months after start of sunitinib (left) and 5 weeks after initiation of sorafenib (right). Micrographs were taken by an Axiolmager M1 (Zeiss) using an EC Plan-Neofluar, 100×/1.3 oil, 0.17 objective lens (Zeiss). (C) Hematologic response to treatment with sunitinib and sorafenib in patient 1 over a 250-day period. AML indicates acute myeloid leukemia.

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