Hypoplastic acute leukemia

Abstract

There have been few reports of acute leukemia presenting with a hypocellular bone marrow. All patients diagnosed as having acute leukemia were identified during a recent six-year interval who had blast cells plus promyelocytes of greater than 30% and marrow cellularity of needle biopsy less than or equal to 50%. Of 195 patients analyzed, 15 (7.7%) fulfilled the criteria. Ten patients were men and five women; the median age was 68 years with a range of 40-82. Seven complained of fatigue of 6-12 months duration, five were seen with occult infection, and three were asymptomatic. Hepatosplenomegaly was absent in 93% and none had lymphadenopathy. Fourteen patients were pancytopenic with median leukocyte count at presentation of 1.5 X 10(9)/liter, hemoglobin of 9.0 g/dl, and platelet count of 55 X 10(9)/liter. Circulating blast cells were not observed in ten patients; in the other five they were less than 0.7 X 10(9)/liter. The morphology of all cases appeared myeloid and Auer rods were seen in three patients; however, in one the peroxidase was negative. Classification according to FAB criteria revealed ten to be M1, three to be M2, one M4, and one L2. Median survival of the entire group was seven months. Of seven patients receiving no chemotherapy, two survived longer than 1 year (14, 24.5 months), one is alive at 7+ months, and the median survival was seven months. Eight patients with life-threatening complications received various combination regimens including an anthracycline, cytosine arabinoside, 6-thioguanine, vincristine, and prednisone. Five died of treatment complications; two achieved durable complete remission and are free of disease at 17 and 27 months. It can be concluded that hypoplastic acute leukemia is a distinct nosologic entity affecting primarily older patients with myeloid leukemia. Remission induction therapy in patients who are seriously ill has a low success rate, and in some patients prolonged survival is possible with supportive care alone.

Hypocellular acute myeloid leukemia in adults: analysis of the clinical outcome of 123 patients

“…One possible explanation, put forward in prior reports, is that the more indolent and slowly progressing nature of hypocellular AML offsets the possible increased morbidity and mortality from the intense chemotherapy. 2 Patients included in this analysis underwent age-appropriate induction therapy and results suggest that appropriately aggressive therapy and supportive care delivered to these patients may play a role in equalizing their outcome with that of patients with non-hypocellular AML. For example, the complete remission rate of 54% in our cohort is better than historical rates, such as the 25% (2/8) in the report by Needleman.…”

“…Its frequency ranges between 5-12% of all cases of AML. 1,2 Published reports are based on small numbers of patients and do not include a comparison with other AML patients. Hypocellular AML is currently defined as AML with a bone marrow cellularity less than 20%, although in some earlier reports, cellularity less than 40% or 50% was considered to be hypocellular.…”

“…Hypocellular AML is currently defined as AML with a bone marrow cellularity less than 20%, although in some earlier reports, cellularity less than 40% or 50% was considered to be hypocellular. [2][3][4][5] Its diagnosis poses a challenge to hematopathologists because of the features in common between hypocellular AML and hypocellular myelodysplastic syndrome and aplastic anemia, including cytopenias and dysplasia; this is particularly the case in the few instances in which cellularity is extremely low. Guidelines were, therefore, proposed to facilitate the diagnosis.…”

Successful Hematopoietic Reconstitution with Granulocyte Colony-Stimulating Factor in a Patient with Hypoplastic Acute Myelogenous Leukemia.

“…Hypoplastic acute myelogenous leukemia (AML)is a syndromethat includes pancytopenia and hypocellular marrow with an evident increase of leukemic blast cells in a proportion of 15-75% of marrow nucleated cells (1,2). This disease mainly affects the elderly and accounts for 5-7% of de novo AML (3).…”

“…Median survival without therapy is 6 to 9 months and most patients die of infectious episodes (2,3). Recently, the beneficial effects of hematopoietic growth factors have been reported in the treatment of hypoplastic AML(4-7).…”