Hypoplastic acute leukemia: description of eight cases and search for hematopoietic inhibiting activity

Bock, R. De; Jonge, M. de; Korthout, Marcel; Wouters, E.; Bockstaele, Dirk Van; Planken, Marc van der; Peetermans, M.

doi:10.1007/bf01836068

Cited by 8 publications

(6 citation statements)

References 23 publications

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“…Hypocellular AML is characterized by pancytopenia and bone marrow hypocellularity with equal to or more than 20% blast along with the absence of tumor masses or tissue infiltrates (1.4). In some earlier reports, cellularity \ 40% or 50% was considered as hypocellular [2,[11][12][13][14][15]. This atypical entity is diagnosed more frequently in older patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Treatment Outcome of Hypocellular Acute Myeloid Leukemia Based on WHO Classification

Čolović¹,

Denčić‐Fekete

Peruničić

et al. 2019

Indian J Hematol Blood Transfus

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The hypocellular acute leukemia is very rare atypical leukemia with frequency of 5-7% among patients with acute leukemias. It mainly occurs in older patients and usually has a myeloid phenotype. It is still unclear whether the outcome of hypocellular acute myeloid leukemia is less favorable than adult acute myeloid leukemia with normal cellularity. We retrospectively analyzed all hypocellular acute myeloid leukemias which were treated in 16 years period, between January 1998 and December 2014. There were 33 patients, 21 male and 12 female. The median age of the patients was 58.9 years (ranging from 19 to 88 years) and median cellularity of bone marrow was 16%. All patients presented with cytopenias with median white blood cell count 1.9 9 10 9 /l, platelets 47.2 9 10 9 /l and hemoglobin 85.9 g/l. Nineteen patients were treated with standard 3 ? 7 protocol (daunoblastin 45 mg/m 2 1, 3, 5 days, cytosin-arabinozide 100 mg/m 2 /12 h for 7 days), 5 patients with HDAC protocol and, 3 (9%) with low dose cytosin-arabinoside and in 6 (18.1%) patients only supportive therapy was applied. One patient died on 34 day after treatment with HiDAC, 3 patients after treatment with 3 ? 7 regimen in full doses on days 23, 35, and 58 days. Complete remission was achieved in 20/33 (60.60%) patients, with median duration of 14 months. Median overall survival (OS) of the entire cohort was 16 months, and for the treated group 21 months (range 5-67 months). Median OS of patients treated with low dose cytosinearabinoside was 6 months. The advanced age (p = 0.009, KK = -0.46, Log rank, p = 0.031) as well as therapy options (Log rank p \ 0.0001) shows a significant correlation with OS. We report a cohort of patients with hypocellular acute myeloid leukemia who responded to standard induction chemotherapy as are in standard acute myeloid leukemia.

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Treatment Outcome of Hypocellular Acute Myeloid Leukemia Based on WHO Classification

Čolović¹,

Denčić‐Fekete

Peruničić

et al. 2019

Indian J Hematol Blood Transfus

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“…[ 19 ] G-CSF is known to induce the differentiation of leukemic cells into the monocytic lineage, which causes apoptosis of leukemic cells, both in vivo and in vitro . [ 20 ] G-CSF stimulates the leukemia initiating cells into cell cycle, induces more leukemia cells sensitive to cytarabine, and enhances normal hematopoiesis. [ 19 ] CAG regimen which is similar to HAG, comprises of cytarabine, aclarubicin and G-CSF, which has been widely used in China and Japan for treatment of AML and MDS.…”

Section: Discussionmentioning

confidence: 99%

HAG regimen improves survival in adult patients with hypocellular acute myeloid leukemia

Wang

et al. 2015

Oncotarget

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BackgroundHypocellular acute myeloid leukemia (Hypo-AML) is a rare disease entity. Studies investigating the biological characteristics of hypo-AML have been largely lacking. We examined the clinical and biological characteristics, as well as treatment outcomes of hypo-AML in our institutes over a seven years period.Design and MethodsWe retrospectively analyzed data on 631 adult AML patients diagnosed according to the French-American-British (FAB) classification and WHO classification of tumors of haematopoietic and lymphoid tissue, including 43 patients with hypo-AML. Biological variables, treatment outcomes and follow-up data on hypo-AML patients were analyzed.ResultsOut of 631 AML patients, 47 (7.4%) were diagnosed as hypo-AML, out of which 43 patients were evaluable. Compared with non-hypocellular AML, hypo-AML patients tended to be older (P = 0.05), more likely to present with leukocytopenia (P < 0.01) and anterior hematological diseases (P = 0.02). The overall complete remission (CR) rate, disease free survival (DFS), and overall survival (OS) in hypo-AML patients were comparable to those in non-hypo AML patients. Twenty-seven (62.8%) patients with hypocellular AML were treated with the standard regimen of anthracyclines and cytarabine (XA) (associated CR rate: 51.9%; median OS: 7 months; median DFS: 6.5 months). Sixteen (37.2%) patients were treated with a priming regimen containing homoharringtonine, cytarabine and G-CSF (HAG) (associated CR rate: 81.25%; median OS: 16 months; median DFS: 16 months).ConclusionsThe overall prognosis of hypo-AML was not inferior to that of non-hypo AML. HAG regimen might increase response rates and improve survival in hypo-AML patients.

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“…Researchers have tested serum of patients of HAL and have shown inhibitory role of leukemic blasts on normal hematopoiesis. The inhibitory substances identified include leukemia inhibitor factor (LIF), stem cell inhibitor factor (SCI), tumor necrosis factor (TNF), prostaglandin E, and decreased or aberrant stimulatory factors such as granulocyte colony stimulating factor (G-CSF) [10].…”

Section: Discussionmentioning

confidence: 99%

“…Most case series on HAL are from western countries [2,4,9,10]. On literature search, no large study on HAL could be retrieved from India; reported HAL are restricted to case reports only [11,12].…”

Section: Introductionmentioning

confidence: 99%

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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Hypoplastic acute leukemia: description of eight cases and search for hematopoietic inhibiting activity

Cited by 8 publications

References 23 publications

Clinical Characteristics and Treatment Outcome of Hypocellular Acute Myeloid Leukemia Based on WHO Classification

Clinical Characteristics and Treatment Outcome of Hypocellular Acute Myeloid Leukemia Based on WHO Classification

HAG regimen improves survival in adult patients with hypocellular acute myeloid leukemia

Hypocellular acute leukemia: study of clinical and hematological features

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