Adult (Ph1 positive) chronic granulocytic leukaemia was diagnosed in eight of 123 (6%) consecutive new cases of childhood leukaemia. Four patients presented as typical CGL and four in blast crisis; two of the four chronic cases have since developed blast crisis. Morphological characterization of the blasts in these six acute cases suggested a myeloblastic crisis in one and a lymphoblastic crisis in five. Study of ‘membrane markers’ indicated one myeloid, four lymphoblastic and one mixed lymphoid/myeloid crisis. Remission induction was easily achieved in two of the five lymphoblastic cases; one child relapsed rapidly and the other remains well eighteen months after conversion but serial cytogenetic studies show persistence of the Ph1 chromosome.We conclude that adult CGL in childhood presents frequently as blast crisis and may even mimic ‘good risk’ ALL. Response to treatment cannot be predicted by morphological or immunologies1 characteristics.
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