Leukopenia, Bone Pain, and Bone Necrosis in Patients with Acute Leukemia

Nies, Boyd A.; Kundel, Donald W.; Thomas, Louis B.; Freireich, Emil J.

doi:10.7326/0003-4819-62-4-698

Cited by 83 publications

(47 citation statements)

References 6 publications

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“…The prevalence of this entity changes according to the series from 0.3% to 37% [2,3,6]. It seems to be relatively rare disease in living patients [4].…”

Section: Discussionmentioning

confidence: 98%

“…There was no evidence of BM infiltration in two cases treated at our center. In three cases, BMN developed during or at the end of chemotherapy received for relapse disease (3,6, and 6 courses, respectively). Clinically, pancytopenia was thought to be chemotherapy toxicity, but imaging techniques and in one case liver biopsy showed active disease.…”

Section: Underlying Diseasementioning

confidence: 99%

“…Although autopsy reports show a higher prevalence of this disorder, the prevalence of BMN is highly variable and is a relatively rare entity diagnosed during life [4]. Malignancy, especially hemopoietic neoplasia, is the most common cause of BMN [5][6][7][8][9][10][11][12][13][14][15]. Sickle cell disease (SCD), infections, sepsis, and drug ingestion are nonmalignant causes of BMN [16][17][18][19][20][21][22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

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Bone marrow necrosis: Clinicopathologic analysis of 20 cases and review of the literature

et al. 2002

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Bone marrow necrosis (BMN) is a relatively uncommon clinicopathologic entity. The etiology is diverse, and malignancy, especially hematopoietic in origin, is the most common underlying disease of BMN. In this retrospective analysis, cases with BMN were re-evaluated for etiology, histopathologic details, and clinical manifestations. In the last 8 years, 23 cases of BMN were detected among the 1,083 bone marrow (BM) biopsies, and the prevalence was found to be 2.2%. Three of these 23 cases with BMN were children, and 20 cases were in adults. Sixteen of these cases (80%) had underlying malignant disease, and four (20%) had nonmalignant disease. Among the malignant cases, three cases had acute myeloblastic leukemia (AML), four had relapsed Hodgkin's disease (R-HD), one had acute lymphoblastic leukemia (ALL), two had chronic myelocytic leukemia (CML), two had non-Hodgkin's lymphoma (NHL), three had disseminated intravascular coagulation (DIC) associated with metastatic solid tumor, and one had myelodysplastic syndrome/myeloproliferative syndrome (MDS/MPS). Among the nonmalignant cases, two had tuberculosis infection, one had anti-phospholipid syndrome (APS), and one had a history of drug ingestion. The most common symptoms were bone pain, fever, fatigue, and jaundice. The most common laboratory findings were variable and associated with underlying disease, but anemia, leukopenia, thrombocytopenia, and high LDH and alkaline phosphatase levels were detected in the majority of the cases, as was also seen in other series. BMN was graded according to the extent of necrosis in the BM biopsy, and necrosis was extensive in 12 cases, moderate in five cases, and mild in three cases. Increased reticulin was found in 16 cases; four cases had severe, eight had moderate, and four had mild fibrosis, and this was found to be an interesting accompanying finding in BMN. In conclusion malignancy is the most common cause of BMN but some nonmalignant conditions such as tuberculosis and APS may be the underlying cause of BMN. Am.

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“…The prevalence of this entity changes according to the series from 0.3% to 37% [2,3,6]. It seems to be relatively rare disease in living patients [4].…”

Section: Discussionmentioning

confidence: 98%

Section: Underlying Diseasementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Bone marrow necrosis: Clinicopathologic analysis of 20 cases and review of the literature

et al. 2002

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“…The shared laboratory abnormalities such as a leukoerythroblastic blood picture, raised alkaline phosphatase and LDH levels seen in others. 1,2,7 However, abnormalities such as hypercalcaemia 2 and disseminated intravascular coagulation 2 were not evident.…”

Section: Discussionmentioning

confidence: 99%

“…Extensive BMN is a rare finding in living patients and is seen predominately in malignant infiltration of the bone marrow such as ALL and lymphoma. 1,2,7 The incidence has ranged from 0.15% (one in 664) to 0.4% (one in 202) of bone marrow biopsies over a period of 10 and 12 years, respectively. 2,4 Besides the cardinal symptoms of bone pain and fever, 2 our patient also had a precipitous drop in the blood counts.…”

Section: Discussionmentioning

confidence: 99%

Bone marrow necrosis in bone marrow transplantation: the role of MR imaging

Chim

Ooi

et al. 1998

Bone Marrow Transplant

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Summary:We describe an ALL patient who developed extensive bone marrow necrosis at the time of relapse 2 months after allogeneic bone marrow transplantation from an HLA-identical sibling. The excruciating and diffuse bone pain, fever and precipitous drop in peripheral blood counts were characteristic. This case illustrates the importance of repeat bone marrow biopsies for the diagnosis of disease relapse and the potential application of MR imaging in the assessment of patients with bone marrow necrosis.

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Bone Marrow Necrosis

Carloss¹

1977

Arch Intern Med

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Leukopenia, Bone Pain, and Bone Necrosis in Patients with Acute Leukemia

Cited by 83 publications

References 6 publications

Bone marrow necrosis: Clinicopathologic analysis of 20 cases and review of the literature

Bone marrow necrosis: Clinicopathologic analysis of 20 cases and review of the literature

Bone marrow necrosis in bone marrow transplantation: the role of MR imaging

Bone Marrow Necrosis

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