**3.4 Five-way translocation of Ph chromosome**

Five-way translocation is involved in five chromosomes including the Ph chromosome. A novel five-way translocation involved in chromosomes 7, 11, 9, 22, and 9 detected by G-banding technique and confirmed by spectral karyotyping (SKY); BCR-ABL gene was detected by fluorescence in-situ hybridization (FISH), which was reported by Yokota group in 2012, and patients showed good respond to imatinib treatment and also reviewed another nine cases of five-way translocations compared with their case reported in that article [36].

Another five-way translocations of 29-year-old male CML case involved in chromosomes 9, 11, 13, 19, and 22 by G-banding technique confirmed by SKY, and BCR-ABL gene fusion by Vaidya group reported a five-way translocation involved in chromosomes 9, 11, 13, 19, and 22, and that case responded well to imatinib treatment [37].

The mechanism of variant complex translocation is still unknown. The spatial arrangement is involved in chromosomes because they require the physical interaction of the translocation partners and the association of genomic instability could be associated with multiway translocation.
