People are getting about as close as I can ask for so it is probably time to give an answer. If you would rather just play the game, try the other thread first, then come here.

If you keep reading, there will be spoilers. Last chance to try the other thread first.

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ABD2021 and DarkGreen both are close enough for government work at this point.This is why I love io9 and the o-deck. So many smart people.

This is an ALK negative, T-cell, anaplastic large cell lymphoma. There are about 3,500 cases a year. ALK is a marker on the cells that is prognostic. People who are ALK positive have an excellent prognosis with standard chemotherapy, 70% or more are cured. Unfortunately most adults are ALK negative which is worse. Somewhere between 15% and 50% are cured with standard therapy, but with stem cell transplant, maybe as many as 70% can be cured. The broad ranges are due to the rarity of the disease making statistical analysis difficult.

While there is no hard data, I would expect that this karyotype worsens the prognosis. It is hard to believe, but a normal T lymphocyte accumulated all these mutations and became cancer. It didn’t happen all at once, but that cell line accumulated more and more defects until it caused wide spread enlargement of the lymph nodes, weight loss, fevers, and soaking night sweats. There was spread of the disease to the bone marrow, which is where this specimen comes from. Bone marrow involvement is common in aggressive lymphomas. And yes, I personally placed a large needle into the back of this man’s pelvis and cut out some of his bone marrow for analysis. So think twice before messing with me, because I have done this roughly one thousand times to people and I can do it in my sleep.

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I have to admit, this is one of the worst karyotypes I have seen in 19.5 years of oncology. When I first saw it, I was trying to figure out who I had seen with acute leukemia, because that is the sort of disease where you get these multiple abnormalities.

Despite all this nastiness, he is feeling much better after one cycle of treatment and the trick is going to be keeping him that way, which will probably involve four months of chemotherapy and then a stem cell transplant.

I hope everybody enjoyed this game as much as I did.