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

Sohn, Sang Kyun; Suh, Jang Soo; Lee, Jae Tae; Lee, Kyu Bo

doi:10.3904/kjim.1998.13.1.64

Cited by 5 publications

(5 citation statements)

References 21 publications

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“…Peripheral blood smears from these patients showed pancytopenia with infrequent blasts present. The outcomes for ALL matched those mentioned by Sohn et al, 14 The patient was referred to a higher level of care since leukemia cytochemistry was unavailable at the facility.…”

Section: Discussionsupporting

confidence: 55%

Importance of bone marrow examination in cases of pancytopenia: A morphological study in a tertiary care center

Deepshikha Verma,

Ranjan Yadav,

Rajnikant Ahirwar

et al. 2024

Asian J Med Sci

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Background: Anemia, leukopenia, and thrombocytopenia are all combined as pancytopenia. It could be a symptom of many diseases that directly or indirectly impact the bone marrow. The cause of pancytopenia, however, differs depending on the location. An essential step in determining the cause of pancytopenia is bone marrow aspiration (BMA). Aims and Objectives: This study aimed to determine the causes of pancytopenia and the morphology of the bone marrow in pancytopenia patients. Materials and Methods: This study was carried out over a year in the pathology department of a tertiary care facility in central India. Patients taking chemotherapy or radiation therapy were excluded from the study. Inclusion Criteria: Cases with hemoglobin <10 g/dL, total leukocyte count <4000/mm3, and platelet count <100,000/mm3 were included in this study. The patient’s posterior iliac crest was used for BMA. The Leishman stain was used to color BMA smears for microscopy. Results: This study comprised 51 cases of pancytopenia, with acute leukemia and megaloblastic anemia accounting for the majority (11 cases each out of 51), followed by dimorphic anemia (10/51), hypocellular marrow (9/51). The clinical symptom of generalized weakness and pallor was present in all instances (100%) and was followed by fatiguability (72%) and dyspnea (48%). The last two least frequent symptoms, lymphadenopathy, and hepatomegaly, were also present in many patients. A significant proportion of pancytopenia individuals experienced lymphadenopathy and hepatomegaly, which were the last two least prevalent appearances. Conclusion: In most cases, bone marrow aspiration in pancytopenia patients aids in determining the underlying reason. Understanding the illness process, planning future research, and managing cytopenia patients can all benefit from it.

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Section: Discussionsupporting

confidence: 55%

Importance of bone marrow examination in cases of pancytopenia: A morphological study in a tertiary care center

Deepshikha Verma,

Ranjan Yadav,

Rajnikant Ahirwar

et al. 2024

Asian J Med Sci

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“…However, cases of adult ALL manifesting pancytopenia are rare, and may be easily neglected or misdiagnosed; few cases were available in the literature (8,9). In the present case, symptoms of leukemia were not identified in peripheral blood or BM on initial examination.…”

Section: Discussionmentioning

confidence: 62%

“…Routine blood tests revealed leukocytosis, mild anemia and thrombocytopenia. The peripheral blood test identified a white blood cell count of 291.3x10 9 /l (normal range, 4.0-10.0x10 9 /l), hemoglobin levels of 104 g/l (normal range, 110-160 g/l), platelet levels of 18x10 9 /l (normal range, 100-300x10 9 /l) and 85% blast cells (Table I, day 50). Extensive lymphadenopathy and splenomegaly were confirmed by B-mode ultrasound.…”

Section: Case Reportmentioning

confidence: 99%

Transient pancytopenia preceding adult acute lymphoblastic leukemia with chromosomal abnormalities including the Philadelphia chromosome: A case report and review of the literature

Liang

Ding

et al. 2015

Oncology Letters

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Abstract.A preleukaemic phase, typified by transient pancytopenia, is a rare occurrence that usually affects children and adolescents. The present study reports the case of a 50-yearold woman with transient pancytopenia, which manifested as a fever, cough and severe anemia. Three weeks following treatment of pancytopenia with antibiotics, red blood cell and platelet transfusion, granulocyte colony-stimulating factor and human γ globulin, the condition of the patient was improved. However, 3 weeks following discharge from hospital, the patient was diagnosed with acute lymphoblastic leukemia (ALL) with complex chromosomal abnormalities, including Philadelphia chromosome and P190 breakpoint cluster region-ABL. Complete remission was achieved following one course of combination chemotherapy. In conclusion, adult ALL with pancytopenia as a preceding symptom is rare, difficult to diagnose early and easily misdiagnosed. In addition, the pathogenesis of ALL and the precipitating factors underlying this disease require further investigation.

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“…ALL preceding spontaneous recovery of unexplained bone marrow hypoplasia is a rare and highly hypothesized phenomenon 9,10 . It occurs in approximately 2% of cases of ALL, usually amongst females below 10 years of age [9][10][11][12] . This is the first and only case observed at our pediatric cancer center over the last three years.…”

Section: Discussionmentioning

confidence: 99%

“…This is the first and only case observed at our pediatric cancer center over the last three years. Several terms have been used by several authors to describe this phenomenon, including pancytopenic prodrome of ALL, hypoplastic anemia, transient pancytopenia preceding ALL (pre-ALL), or aplastic anemia preceding ALL) [11][12][13][14][15][16] . Some literature, however, describes findings suggestive of aplastic anemia in pre-ALL as "nonclassical" or inadequate to suggest aplastic anemia 10,11 .…”

Section: Discussionmentioning

confidence: 99%

Transient bone marrow hypoplasia preceding T-Cell acute lymphoblastic leukemia: a case report

Naturinda¹,

George²,

Ssenyondwa³

et al. 2021

Afr H. Sci.

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Background: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy and is characterised by hy- perproliferation of malignant lymphocytes in the bone marrow. Rarely, ALL may be preceded by a period of pancytopenia and bone marrow hypoplasia which spontaneously recovers. This phenomenon, which has not before been described in T-cell ALL, is referred to as transient bone marrow hypoplasia. Case presentation: A 5-year-old boy who presented with high-grade fever and generalised lymphadenopathy, was found to have pancytopenia on peripheral blood count and bone marrow hypoplasia. He was observed over a one-month period during which his bone marrow and peripheral blood counts recovered spontaneously. Symptoms recurred after 4 months and he was found to have blast infiltration of the bone marrow and diagnosed with T-cell ALL. Conclusion: Cases of transient bone marrow hypoplasia or overt aplastic anemia with spontaneous recovery and then followed by B-cell ALL or Acute Myeloid Leukemia have been described previously in the medical literature. This is the first case of transient bone marrow hypoplasia resulting into ALL of T-cell immunophenotype. While marrow hypoplasia preceding ALL remains poorly understood, it suggests an antecedent environmental insult to lymphoid progenitors or a germline abnormality that predisposes to lymphoid dysplasia. This may provide clues to the hitherto unknown pathophysi- ological process and etiological factors that precede the majority of childhood ALL cases. This case enlightens pediatricians about the existence of such rare cases so as to periodically follow up children with pancytopenia and/or bone marrow hy- poplasia for prolonged periods even after apparent recovery. Keywords: Pancytopenia, hypoplasia; aplastic anemia; T-cell acute lymphoblastic leukemia; case report.

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

Cited by 5 publications

References 21 publications

Importance of bone marrow examination in cases of pancytopenia: A morphological study in a tertiary care center

Importance of bone marrow examination in cases of pancytopenia: A morphological study in a tertiary care center

Transient pancytopenia preceding adult acute lymphoblastic leukemia with chromosomal abnormalities including the Philadelphia chromosome: A case report and review of the literature

Transient bone marrow hypoplasia preceding T-Cell acute lymphoblastic leukemia: a case report

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