Acute myelogenous leukemia (FAB AML-M1) in the setting of HIV infection and G-CSF therapy: a case report and review of the literature

Abstract

Although hematologic dysplasia is common in HIV disease, evolution to AML is unusual. We report a case of AML in a patient with stage-C3 AIDS who had been previously treated with granulocyte colony-stimulating factor (G-CSF). This 41-year-old black man presented with pancytopenia (Hg 8.6 g/dl, Hct 24.3%, platelets 16,000/mm3, WBC 0.6 x 10(3)/mm3) and hemoptysis. His peripheral smear manifested 19% blasts. His bone marrow biopsy was hypocellular (20%) with greater than 90% blasts, which were positive for myeloperoxidase and Sudan black B. The blasts were negative for nonspecific esterase. Immunophenotypic analysis by flow cytometry showed the majority of cells to be of myeloid lineage, expressing CD13, and CD45 at low intensity. In addition, there was aberrant expression of CD2 and no expression of CD14 or CD4. The diagnosis of AML-FAB-M1 was made. The patient refused chemotherapy. Of the rare cases of AML in HIV patients previously reported in the literature, the majority were of the monocytic or myelomonocytic subtype. This case is of special interest because of prior G-CSF therapy. In this setting, the relationship between HIV, G-CSF, and subsequent AML is controversial.

Acute Myeloid Leukemia Secondary to a Myelodysplastic Syndrome with t(3;3) (q21;q26) in an HIV Patient Treated with Chemotherapy and Highly Active Antiretroviral Therapy

“…Patients were predominantly homosexual men, their median age was 37 years, and the most represented FAB was M4 or M5 [3]; only two cases were secondary to an MDS, which was prior to the antiretroviral therapy. No deaths related to AML treatment were described and the complete remission rate was similar to that obtained in HIV-negative patients [7, 8]. Details relating to HAART are available only in a few patients [2].…”

“…Details relating to HAART are available only in a few patients [2]. The final outcome was generally poor because no durable complete remissions were obtained and all patients died of a progression of leukemia [7]. …”

“…Rare cases of HIV patients developing primary myelodysplastic syndromes (MDS) or acute myeloid leukemias (AML) have been reported and the relationship between immunosuppression related to HIV and leukemogenesis is still a matter of discussion [4, 5]. The prognosis of AML in HIV-positive patients appears to be poor and only few data are available about clinical and biological aspects as an optimal treatment has not yet been established [6, 7, 8]. Survival duration appears to be related to the level of CD4 counts [4], but it is not known whether the use of highly active antiretroviral therapy (HAART) is feasible and tolerable in HIV patients who also receive chemotherapy (CHT) for leukemia, considering the possible pharmacokinetic interactions, potential additive toxicities and delay and/or dose modifications of the antineoplastic treatment.…”

Acute myelogenous leukemia in a child with HIV infection

“…Though myelodysplasia is common in patients with HIV infection, occurrence of AML is extremely rare [1,3,6]. AML may be twofold more common in HIV-infected patients as compared to general (French) population [6].…”

“…The occurrence of acute myelogenous leukemia (AML) in HIV-infected patients is extremely rare with about 53 cases (all adults) reported so far [1][2][3][4][5]. Most hematological malignancies in HIV-infected patients are non-Hodgkin's lymphomas and lymphoblastic leukemia [1,2,4,5].…”