Acute lymphoblastic leukemia of childhood presenting as aplastic anemia: report of two cases

Abstract

Acute lymphoblastic leukemia is the most common malignancy in pediatric patients; its diagnosis is usually easy to establish as malignant lymphoblasts invade the bone marrow and peripheral blood. Some acute lymphoblastic leukemia patients may initially present with pancytopenia and a hypoplastic bone marrow leading to the initial diagnosis of aplastic anemia. In most of these patients clinical improvement occurs, with normalization of the complete blood count within six months, although recovery can also develop a few weeks after initiating steroid therapy. The etiologic relationship between the aplastic anemia features and the subsequent overt development of acute lymphoblastic leukemia has not been established. We describe the cases of two children who presented with severe infection and signs and symptoms of aplastic anemia confirmed by bone marrow aspirate and bone marrow biopsy that developed acute lymphoblastic leukemia thereafter. No specific therapy for aplastic anemia was administered, nevertheless a full spontaneous recovery was observed in both cases. Acute lymphoblastic leukemia was successfully treated with standard chemotherapy, both children remaining in complete remission 16 and 17 months after their initial aplastic anemia diagnosis.

Transient pancytopenia preceding adult acute lymphoblastic leukemia with chromosomal abnormalities including the Philadelphia chromosome: A case report and review of the literature

“…However, to date, pre-ALL remains a rare and uncertain condition. A number of studies have demonstrated that transient pancytopenia, another bone marrow disorder, may be associated with ALL in children and adolescents (3,4). The typical pancytopenic phase, which lasts from several weeks to several months, is transient, followed by spontaneous remission or remission induced by corticosteroids, and subsequent transformation into common ALL (5).…”

Massive Pneumonia and Pancytopenia Leading to the Diagnosis of Acute Lymphoblastic Leukemia in Child – A Case Report and a Review of the Literature

“…Certain studies underlined the fact that the development of ALL involves genetic disorders, chromosomal abnormalities mostly acquired during fetal hematopoiesis that will result in a subclinical preleukemic clone and/or postnatal secondary genetic changes (14). Nevertheless, the precise event that will determine the preleukemic clones to evolve into an overt ALL remains unidentified (9). Other studies sustain the idea the development of ALL would be attributed to a lack of mobilization of the immune system as a result of insufficient exposure to infectious agents (15).…”

“…On one hand, similarly to the previous mentioned data from the literature, the age of our patient was 2 years, but on the other hand he was a boy. Also, Villarreal-Martínez et al reported two pediatric cases of ALL presenting as aplastic anemia (9). The first one described a 5-year-old male who presented with a perianal abscess whose CBC count revealed a Hb of 5.0 g/dL, and also leukopenia and thrombocytopenia.…”

“…Due to the excessive accumulation of abnormal, leukemic cells in the bone marrow and peripheral blood, the most frequent symptoms encountered in patients with ALL are: frequent infections or other flu-like symptoms, fever, anemia, bleeding, fatigue (7). Nevertheless, certain studies proved that transient pancytopenia can be related to ALL in children and adolescents (8,9). This transient pancytopenic phase is rare and it can occur in approximately 2% of pediatric ALL cases, being considered a preleukemic condition (pre-ALL) (10).…”

Serum amyloid A1 and plasminogen as predictory proteins to monitor the progression of preleukemic diseases towards acute lymphoblastic leukaemia

“…10 Some case studies have reported this type of conversion of APA to ALL. [11][12][13][14][15][16][17][18][19] Currently, molecular genetics, cytogenetics, and morphologic, biochemical and immunologic characteristics of lymphoblasts are needed to make the correct diagnosis and classication, 20 and to perform all these tests, a bone marrow puncture is required, which is quite painful and invasive, particularly for children. Therefore, diagnostic procedures need to be improved for timely diagnosis using minimal invasive tests.…”