Leukemoid Reaction in Association with Bone Marrow Necrosis due to Metastatic Prostate Cancer

Abstract

An 80-year-old man presented to the internist with fever, fatigue and leukocytosis up to 66.8×10 3 / l. Although a chronic myelogenous leukemia was initially suspected, he was diagnosed as metastatic bone marrow tumor with bone marrow necrosis from primary prostate cancer on the basis of the clinical and pathological findings. The serum concentrations of IL-6 and TNF-were mildly elevated to 65.0 pg/ml and, 54.0 pg/ml respectively. It is probable that these humoral factors were partially responsible for the leukemoid reaction although other factors induced by the bone marrow necrosis with bone marrow metastasis of prostate cancer are also likely involved. (Internal Medicine 44: 1093-1096, 2005)

Paraneoplastic Leukemoid Reaction in Solid Tumors

“…6 In our case, we performed a flow cytometric analysis of the peripheral blood, which showed normal myeloid precursors, although there was a left shift indicating rapid myeloproliferation. A LAP score that is higher than normal generally favors a benign etiology, whereas a low score should prompt evaluation for possible chronic myeloid leukemia (CML) or paroxysmal nocturnal hemoglobinuria.…”

“…Several categories of PNS exist including cutaneous, hematologic, rheumatologic, endocrine, neurologic, and ocular manifestations. 6 We reviewed the Medline database through PubMed for articles describing leukemoid reaction in association with solid tumors. Neutrophils are generally the predominant white cell type in these cases.…”

Paraneoplastic leukemoid reaction – poor prognostic marker in urothelial bladder carcinoma

“…Th e levels of IL-1[alpha and beta], IL-3, G-CSF, GM-CSF, IL-6, and TNF-[alpha] have all been reported to be elevated in various solid tumors and suggested to contribute to an elevated leukocyte count. 3 With previous reports that receptors for G-CSF have been found on cell surfaces of several nonhematopoietic cell types, Tachibana and Murai have proposed the mechanism of a cancer cell's simultaneous acquisition of the ligand promotion and its receptor expression conferring an autocrine growth advantage. 4 Th ey have also reported on the capability of bladder cancer cells to induce a leukemoid reaction in their host through the stimulation of leukocyte production, which has been associated with aggressive tumor cell growth and a poor clinical outcome.…”

Diffuse osteolytic lesions in leukemic transformation of myelofibrosis

“…Osteolytic lesions in myelofibrosis have been described but rarely and only in irradiated patients (1,11). Association of bone marrow necrosis and elevated TNF-α was described in leukemoid reaction in patients with metastatic prostate cancer (15). Proliferation of the stromal cells, which produce marrow fibrosis may also induce TNF-mediated bone destruction.…”