Leukemic infiltration of the lung following allogeneic hematopoietic stem cell transplantation

Abstract

Pulmonary leukemic infiltration (PLI) is more common than generally recognized, but accurate antemortem diagnosis with pathological proof is rarely achieved. We describe herein the clinical courses of two patients with PLI following hematopoietic stem cell transplantation (HSCT). One case is a male patient with acute biphenotypic leukemia, and the other is a female patient with myelodysplastic syndrome. In both cases, hyperleukocytosis did not proceed to PLI. Moreover, the former case presented PLI as the initial manifestation of relapsed leukemia and the latter was accompanied with the fungal pneumonia. High-resolution computed tomography (HRCT) of the chest at onset of PLI showed diffuse small nodular lesions along peribronchovascular bundle, and diagnosis of leukemic infiltration was made based on pathological findings obtained from transbronchial lung biopsy. Biopsy specimens further revealed leukemic infiltration along the lymphatic surrounding the peribronchial or perivascluar regions, which corresponded well with HRCT findings. Thus, radiological and pathological corroborating assessment was important to reach the correct diagnosis.

Advances in understanding the pulmonary infiltration in acute promyelocytic leukaemia

“…In patients with DS, infiltration of other organs such as the spleen, the lymph nodes, the kidney, the liver, the skin, the pleura and the pericardium has also been reported, but the lung appears to be the clinically most relevant target organ (Frankel et al , 1992; Tallman et al , 2000). Symptomatic pulmonary disease caused by leukaemic infiltrates is uncommon in non‐APL malignancies and is usually associated with hyperleucocytosis, although it has occasionally been reported in the absence of hyperleucocytosis (Kovalski et al , 1990; Azoulay et al , 2003; Potenza et al , 2003; Mulabecirovic et al , 2004; Koh et al , 2005; Wu et al , 2008; Kakihana et al , 2009).…”