Box 1.

Case history

A 49-year-old man presented to accident and emergency with tiredness and breathlessness. Full blood count showed white cell count 328 × 109/L, haemoglobin 79 g/L, and platelet count 28 × 109/L. Fig 1 shows the centrifuged blood sample and the blood film, revealing large numbers of primitive lymphoblasts. Flow cytometry confirmed a diagnosis of ALL and cytogenetic analysis revealed the presence of the t(9;22) translocation consistent with this diagnosis. The patient was referred for urgent leukopheresis and commenced intensive chemotherapy with close monitoring for tumour lysis syndrome. He achieved morphological remission of the bone marrow with induction chemotherapy plus imatinib followed by consolidation treatment prior to allogeneic stem cell transplantation.