Distinction between aleukaemic prodrome of childhood acute lymphoblastic leukaemia and aplastic anaemia.

Reid, M M; Summerfield, G P

doi:10.1136/jcp.45.8.697

Cited by 23 publications

(17 citation statements)

References 6 publications

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“…An increase in bone marrow reticulin may be seen in ND not done hypoplastic AML and hypoplastic MDS but is not increased in AA [17]. Previous studies have also shown increase in reticulin in hypocellular ALL [18,19]; however, our single case of hypocellular ALL did not show increased reticulin, and overall also only one case had increased reticulin fibrosis.…”

Section: Discussionsupporting

confidence: 44%

Hypocellular acute leukemia: study of clinical and hematological features

et al. 2014

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Hypocellular acute leukemia was previously referred to as smoldering leukemia. This is currently defined as having ≥20 % blasts in peripheral blood or bone marrow with cellularity of less than 20 % in bone marrow biopsy at presentation. Hypocellular variants of acute myeloid leukemia (AML) are commoner than that of acute lymphoid leukemia (ALL). They may pose a diagnostic challenge to the treating clinician and pathologist as they can simulate hypoplastic myelodysplastic syndrome and aplastic anemia. It is of utmost importance to distinguish these overlapping disorders as treatment modalities differ. Details of clinical features, complete blood counts, bone marrow aspirate findings, percentage cellularity, pattern of infiltration in trephine biopsies, and immunophenotyping by flow cytometry or immunohistochemistry were analyzed in cases diagnosed as hypocellular acute leukemia. Hypocellular acute leukemia constituted 2.5 % (8/316) of all diagnosed cases of acute leukemia during the study period. Seven of the eight cases of hypocellular acute leukemia were hypocellular AML while one was hypocellular ALL. Median age of patients was 45 years, with a male:female ratio of 1.7:1. Mean duration of symptoms was 1.2 months, with most common presenting feature being fever. None of the patients except one had an antecedent hematologic disorder or chemotherapy or radiotherapy. Hypocellular acute leukemia is important to recognize from other overlapping disorders. Clinical parameters and laboratory data including immunophenotyping can aid in distinguishing them.

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Section: Discussionsupporting

confidence: 44%

Hypocellular acute leukemia: study of clinical and hematological features

et al. 2014

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“…Pancytopenic phase(pre-ALL) associated with a hypocellular or normocellular bone marrow may precede the diagnosis of acute lymphoblastic leukemia(ALL). There have been several reports about names to describe this condition, usually in childhood, which include aleukemic prodrome, preleukemic ALL, aplastic presentation of ALL, hypoplastic preleukemia 1 – 4 ) . There are also several reports 5 – 7 , 22 ) that present the pathogenesis of pre-ALL and conclude that the pre-leukemic aplasia in childhood is a feature of ALL.…”

Section: Introductionmentioning

confidence: 99%

Pancytopenic Prodrome pre - ALL of Acute Lymphoblastic Leukemia in Adults ; Possible Pathogenesis

Sohn

Suh

Lee

et al. 1998

Korean J Intern Med

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We report two cases of adult acute lymphoblastic leukemia presenting with preleukemic phase of pancytopenia with a few abnormal lymphoid cells in bone marrow aspirates. The initial diagnosis of each case was suspicious aplastic anemia and hypoplastic anemia. Both cases progressed to overt acute lymphoblastic leukemia within 1 year. We suggest that initial pancytopenic phase (pre-ALL) may precede the diagnosis of acute lymphoblastic leukemia in adults and differential diagnosis from myelodysplastic syndrome and primary aplastic anemia will be needed. We also suggest that primary bone marrow lymphoma and “primary unknown metastatic lymphoma of bone marrow” may be possible as the pathogenesis in a case like ours.

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“…Occasional cases of marrow hypoplasia or aplasia in childhood subsequently evolve into a frankly leukaemic phase, usually acute lymphoblastic leukaemia (ALL) (Melhorn et al, 1970;Breatnach et al, 1981;Saarinen & Wegelius, 1981;Klingemann et al, 1986;Cheng et al, 1987;Reid & Summerfield, 1992;D'Alessio et al, 1993;Liang et al, 1993;Matloub et al, 1993;Sato et al, 1993). In some cases the leukaemia becomes evident after a prolonged period of hypoplasia, but in others the patient appears to recover only to subsequently develop leukaemia.…”

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confidence: 99%

Leukaemia presenting as marrow hypoplasia: molecular detection of the leukaemic clone at the time of initial presentation

et al. 1997

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Summary. Occasional cases of transient marrow hypoplasia in childhood evolve into acute leukaemia. We studied two children who presented with marrow hypoplasia following infection and who developed acute lymphoblastic leukaemia 2-3 months later. A simple polymerase-chain-reaction (PCR) test for monoclonality showed that immunoglobulin heavychain gene rearrangements of the same size were present at the times of both hypoplasia and leukaemia, and DNA sequencing confirmed identity of these rearrangements. PCR-based quantification, using patient-specific primers, showed in both patients that the leukaemic clone made up 20-25% of the marrow cells during hypoplasia. In contrast, four patients with typical aplastic anaemia showed only polyclonal B-cell populations in the marrow. We conclude that the leukaemic clone was already present at the time of hypoplasia in the two index patients and that in future a simple PCR test for monoclonality could be used to screen patients with marrow aplasia or hypoplasia for the presence of a monoclonal B-cell population. Patients with monoclonal populations could then be monitored carefully for subsequent development of leukaemia.

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Distinction between aleukaemic prodrome of childhood acute lymphoblastic leukaemia and aplastic anaemia.

Cited by 23 publications

References 6 publications

Hypocellular acute leukemia: study of clinical and hematological features

Hypocellular acute leukemia: study of clinical and hematological features

Pancytopenic Prodrome pre - ALL of Acute Lymphoblastic Leukemia in Adults ; Possible Pathogenesis

Leukaemia presenting as marrow hypoplasia: molecular detection of the leukaemic clone at the time of initial presentation

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