The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 40-year-old woman with a past medical history of hypertension and occasional premature ventricular contractions was found on routine blood work in June 2011 to have mild thrombocytosis, with a platelet count of 405,000. In November 2011, repeat analysis revealed a platelet count of 433,000, and by February 2012 her platelet count was 509,000. She had no evidence of leukocytosis or anemia and no symptoms of early satiety, night sweats, pruritus, or erythromelalgia. She was referred to a hematologist for evaluation of persistent isolated thrombocytosis in March 2012. Her spleen was not palpable, and a quantitative polymerase chain reaction (PCR) test for JAK2/V617F was negative. A bone marrow biopsy and aspiration revealed a mildly hypercellular marrow (70% to 80% cellularity), with an elevated myeloid:erythroid ratio of 5:1, increased megakaryocytes including micromegakaryocytes in the absence of increased blasts. Cytogenetic analysis revealed the presence of the Philadelphia chromosome translocation in 17 out of 20 metaphases. The remaining three metaphases were normal karyotype. Quantitative PCR for BCR-ABL1 yielded a value of 29.6% on the International Scale.

中文翻译：

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慢性期慢性粒细胞白血病的一线治疗选择

Oncology Grand Rounds 系列旨在将发表在期刊上的原始报告纳入临床背景。病例介绍之后是诊断和管理挑战的描述、相关文献的回顾以及作者建议的管理方法的总结。本系列的目标是帮助读者更好地了解如何将关键研究的结果（包括发表在《临床肿瘤学杂志》上的研究）应用于他们自己的临床实践中看到的患者。一名 40 岁女性，既往有高血压病史，偶有室性早搏，2011 年 6 月查血常规，血小板轻度增多，血小板计数 405,000。2011 年 11 月，重复分析显示血小板计数为 433,000，到 2012 年 2 月，她的血小板计数为 509,000。她没有白细胞增多或贫血的证据，也没有早饱、盗汗、瘙痒或红斑性肢痛症的症状。2012 年 3 月，她被转诊到血液科以评估持续性孤立性血小板增多症。她的脾脏无法触及，JAK2/V617F 的定量聚合酶链反应 (PCR) 检测结果为阴性。骨髓活检和抽吸显示轻度多细胞骨髓（70% 至 80% 细胞结构），髓系：红细胞比升高 5:1，巨核细胞增加，包括在原始细胞没有增加的情况下微巨核细胞。细胞遗传学分析显示，20 个中期中有 17 个存在费城染色体易位。其余三个中期核型正常。BCR-ABL1 的定量 PCR 产生的值为 29。