Severe aplastic anemia preceding acute lymphoblastic leukemia

Abstract

Background. Bone marrow aplasia preceding acute lymphoblastic leukemia (ALL) is a rare condition that usually affects children. The ALL generally follows the recovery of normal blood counts and most commonly occurs within 6 months of the onset of aplasia. The case of a patient with severe aplastic anemia is reported in whom ALL developed 15 months after the initial diagnosis of aplastic anemia. A literature search found 23 cases of ALL after a period of aplasia or hypoplasia. This patient's disease, however, was different from all previously reported ones. The severe aplasia lasted 15 months before being followed by ALL. There was no recovery of blood counts before the onset of ALL. Methods. A review of the literature found 23 case reports in which aplasia or hypoplasia preceded ALL; these patients also had pancytopenia of the peripheral blood. Excluded from this review were patients whose bone marrow was hypoplastic, but who did not have pancytopenia because these did not have “aplastic anemia” as their initial disease. Results. Analysis of the reported patients showed that most were girls 10 years of age or younger. There was an overwhelming prevalence of fever, which in several instances, might have had an infectious cause. ALL most commonly occurred within 6 months of the aplasia and usually followed the recovery of normal blood counts. Conclusions. Patients with ALL after a prolonged period of aplasia have several common characteristics including female sex, young age, and the prevalence of fever, often associated with an infectious illness. ALL usually follows the recovery of blood counts and occurs within 6 months of the onset of aplasia. The pathophysiology of this patient's disease(s) is still unclear. He could have had two unrelated disorders or a two‐step leukemic process that followed a stem cell “insult.” This patient had an antecedent hepatitis A infection 3 months before aplasia occurred. However, the authors were unable to identify with certainty any other event that might have caused additional bone marrow injury. Cancer 1993; 71:264‐8.

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

“…Since it is difficult to explain how pre-ALL transforms into ALL over the period of a few days to several weeks, the hypothesis that leukemia occurs prior to pre-ALL may be plausible (14). Numerous retrospective studies in children have indicated that pediatric patients have normal chromosomes during the pancytopenic period and then abnormal karyotypes may be detected in the ALL period (3,14). For this reason, it has been suggested that the former and the latter are distinct stages of one disease.…”

“…For this reason, it has been suggested that the former and the latter are distinct stages of one disease. For example, cells with a normal karyotype proliferate in the forms of colonization, followed by abnormal chromosome changes that manifest as the clinical symptoms of typical ALL (14,15). It has therefore been hypothesized that the pancytopenic period observed in such patients occurred as a result of the inherent characteristics of leukemia cells.…”

Leukaemia presenting as marrow hypoplasia: molecular detection of the leukaemic clone at the time of initial presentation

“…Occasional cases of marrow hypoplasia or aplasia in childhood subsequently evolve into a frankly leukaemic phase, usually acute lymphoblastic leukaemia (ALL) (Melhorn et al, 1970;Breatnach et al, 1981;Saarinen & Wegelius, 1981;Klingemann et al, 1986;Cheng et al, 1987;Reid & Summerfield, 1992;D'Alessio et al, 1993;Liang et al, 1993;Matloub et al, 1993;Sato et al, 1993). In some cases the leukaemia becomes evident after a prolonged period of hypoplasia, but in others the patient appears to recover only to subsequently develop leukaemia.…”

Hypocellular acute leukemia: study of clinical and hematological features

“…Hypocellular acute leukemia (HAL) is currently defined as acute leukemia with a bone marrow cellularity ≤20 %, although in some reports, cellularity less than 40 % is considered to be hypocellular [1][2][3]. Acute myeloid leukemia (AML) has been reported to be much more common than acute lymphoblastic leukemia (ALL) [4,5]. The incidence of hypocellular AML ranges between 5 and 12 % of all cases of AML [1,6].…”