Myeloblastic transformation of chronic neutrophilic leukaemia
Bibliographic record
Abstract
A 68-year-old woman presented with marked neutrophilia. Her blood counts showed a white cell count of 42 × 109/l with 88% neutrophils, immature granulocytes <1% and no blasts; haemoglobin and platelet count were normal. The neutrophils showed heavy granulation (left panel). The patient had no constitutional symptoms and no evidence of infection, inflammation or malignancy. She had mild hepatomegaly but no splenomegaly or lymphadenopathy. Bone marrow aspirate and trephine biopsy showed hypercellularity because of marked granulocytic hyperplasia. Neither a Ph chromosome nor BCR-ABL fusion was detected by cytogenetic analysis, interphase fluorescence in situ hybridisation or polymerase chain reaction analysis. Neutrophil alkaline phosphatase was elevated with a score of 400 (normal range 40–100). The diagnosis of chronic neutrophilic leukaemia was made in accordance with current World Health Organization diagnostic criteria. The patient remained asymptomatic and so the patient was not treated. Her neutrophilia persisted for over 40 months but the neutrophil count then declined spontaneously and quickly (bottom panel). Blasts emerged and increased in the peripheral blood as neutrophilia subsided (right panel), and anaemia and thrombocytopenia developed. Repeated bone marrow examination showed a hypercellular marrow with >80% myeloblasts. Cytogenetic analysis showed a complex karyotype: 47,XX,+21[4]/47,XX,i(21)(q10),+i(21)[13]. This combination of trisomy 21 and isochromosome 21 resulted in five copies of 21q in some cells. The patient responded well to a course of induction chemotherapy for acute myeloid leukaemia, but subsequently developed severe cytopenia and died following consolidation chemotherapy. Chronic neutrophilic leukaemia is a rare entity within the myeloproliferative diseases. Myeloblastic transformation has been reported to occur following treatment with hydroxycarbamide. This patient had a spontaneous acute transformation. The progression from a normal karyotype in chronic phase to the presence of multiple copies of the long arm of chromosome 21 in acute transformation suggests a mechanism for the transformation.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".