Acute lymphoblastic leukemia is typically characterized by leukocytosis, resulting from the uncontrolled proliferation of malignant cells. However, we report an atypical case of acute lymphoblastic leukemia that presented with leukopenia and exhibited a protracted clinical course spanning 6 months. The patient, a 45-year-old female, initially presented to our hospital with recurrent fever and was found to have lymphoblasts in a hypoplastic bone marrow. Upon further investigation, the patient was diagnosed with B-cell lymphoblastic leukemia, not otherwise specified, based on cell surface antigen expression and genetic abnormalities. Notably, the patient demonstrated persistently low white blood cell and neutrophil counts, without evidence of increasing lymphoblast infiltration in the bone marrow during the ensuing 6-month period. Subsequent chemotherapy led to normalization of hematopoiesis and disappearance of lymphoblasts, resulting in complete remission of the disease.

Lymphoid malignancies are associated with autoimmune cytopenia (AIC); however, their possible associated characteristics/complications remain unclear. This study aimed to retrospectively analyze the correlation between elevated immunoglobulin (Ig) levels and the frequency of AIC complications in 155 patients diagnosed at our hospital with lowgrade B-cell malignancies (LGBCM). Among the 155 patients, 6 had AIC, of whom four had elevated Ig levels. Three of these four patients had monoclonal IgG, and one of them also had polyclonal IgM. The remaining patient had only polyclonal IgM. Patients with monoclonal IgG had a significantly higher prevalence of AIC (p＝0.018). However, in patients with elevated polyclonal IgG levels or elevated monoclonal IgM and IgA levels, there was no significant difference in the frequency of AIC complications. In patients with LGBCM and monoclonal IgG, it is necessary to pay attention to AIC complications.

Bone marrow necrosis (BMN) occurs most frequently in hematological malignancies and sometimes in non-hematological disorders. Lymphoid diseases causing necrosis are regarded as high-grade disease. B-lymphoblastic leukemia/lymphoma is the most common malignant cause of BMN. Here, we present two patients with follicular lymphoma (FL) and MYC gene abnormalities who developed BMN. In one case of BMN, the necrosis disappeared in response to chemotherapy, and the patient survived with complete remission. In the other case, BMN remained even after chemotherapy, and effective chemotherapy could not be administered due to suppressed hematopoiesis, which led to the lymphoma worsening and the patient's death. Indolent lymphomas, such as FL, as in these cases, have the potential to develop BMN. It is important to detect the development of BMN and administer chemotherapy early to improve patient prognosis, since severe BMN prevents patients from receiving effective treatment.