Medicine

A 62-year-old man reports early satiety, fatigue, and generally feeling unwell. On examination he has a large spleen, appears pale, and the rest of the examination is normal. His blood count is abnormal; the WBC is 50,000/mL with increased mature granulocytes, hemoglobin 9.5 g/dL, and platelets 450,000/mL. Which of the following cytogenetic changes is most characteristic of his condition?