Medicine

A 62-year-old man reports early satiety, fatigue, and generally feeling unwell. The symptoms started gradually and are getting worse. He notes no chest discomfort, respiratory symptoms, or abdominal pain.On physical examination, he appears pale, the vital signs are normal, and the pertinent findings are a large spleen, absence of lymph nodes, and normal heart and lung.His blood count is abnormal; the WBC is 50,000/mL with increased mature granulocytes, hemoglobin is 9.5 g/dL, and platelets are 450,000/mL. Which of the following cytogenetic changes is most characteristic of his condition?