HEMATOLOGIC MALIGNANCY

Leucemie mieloidă acută M1 FAB secundară sindromului mielodisplazic cu exces de blaşti de tip 2

 Acute myeloid leukemia M1 FAB secondary to myelodysplastic syndrome with excess blasts type 2

First published: 25 octombrie 2021

Editorial Group: MEDICHUB MEDIA

DOI: 10.26416/OnHe.56.3.2021.5650

Abstract

Acute myeloid leukemia occurs naturally in the evolution of myelodysplastic syndrome (MDS), typically in MDS with excess blasts type 2. The risk of progression is around 33%. We present the case of an elderly patient who was diagnosed with MDS single dysplasia in 2016. He was treated with erythropoietin. In 2021, the disease evolved into MDS with excess blast type 2 and then in acute myeloid leu­ke­mia in a short period of time.
 

Keywords
myelodysplastic syndrome, acute myeloid leukemia, excess blast type 2

Rezumat

Leucemia acută mieloidă reprezintă o complicaţie evolutivă a sin­dromului mielodisplazic, mai ales în cazul mielodisplaziei cu exces de blaşti de tip 2, la care rata de progresie spre leu­ce­mie acută atinge un procentaj de 33%. Prezentăm cazul unui pa­cient vârstnic, diagnosticat cu sindrom mielodisplazic cu dis­pla­zie unilineală în anul 2016, în tratament cu eri­tro­po­ie­ti­nă. În anul 2021, pacientul evoluează spre sindrom mie­lo­dis­pla­zic cu exces de blaşti de tip 2, apoi prezintă o evoluţie rapidă spre leu­cemie acută mieloidă.
 

Introduction

We report the case of a 76-year-old male patient who was diagnosed in 2016 with myelodysplastic syndrome (MDS) single lineage dysplasia, treated with erythropo­ietin. Since 2018, the patient was lost from the follow-up. He returned in our department in September 2021. The patient has multiple comorbidities, such as nephrological pathologies – chronic urinary infections, operated urinary bladder tumor –, cystectomy with cutaneous ureterostomy and double J stents, along with chronic renal disease on hemodialysis program.

At the end of September 2021, the patient was admitted in our department for pancytopenia. We proceeded with the hematological investigations. The peripheral blood smear was without any blasts. We performed a bone marrow aspiration and biopsy, and both of them showed a medullary infiltrate with 20% blasts (Figure 1), respectively 11-12% blasts. We establish the diagnosis: MDS with excess blast type 2.
 

Figure 1. Bone marrow aspirate smear,  May-Grunewald-Giemsa stain, X100.  A, B: Normal cellularity, medium size blasts, round-oval nucleus, fine chromatin, with nucleoli, slightly basophilic cytoplasm.  B: Blasts with bi-lobed nucleus (green arrow)
Figure 1. Bone marrow aspirate smear, May-Grunewald-Giemsa stain, X100. A, B: Normal cellularity, medium size blasts, round-oval nucleus, fine chromatin, with nucleoli, slightly basophilic cytoplasm. B: Blasts with bi-lobed nucleus (green arrow)

After one week, in October 202
 

Figure 2. Bone marrow aspirate smear,  May-Grunewald-Giemsa stain, X100.  A, B: Hypercellular bone marrow, medium size blasts, round-oval nucleus, fine chromatin, with nucleoli, slightly basophilic cytoplasm, with vacuole in both cytoplasm and nucleus, some with cytoplasm extensions
Figure 2. Bone marrow aspirate smear, May-Grunewald-Giemsa stain, X100. A, B: Hypercellular bone marrow, medium size blasts, round-oval nucleus, fine chromatin, with nucleoli, slightly basophilic cytoplasm, with vacuole in both cytoplasm and nucleus, some with cytoplasm extensions

1, the patient came to the emergency unit with asthenia and spontaneous bruises. He was hospitalized in our department. The laboratory tests revealed severe pancytopenia and 6% blasts on the peripheral blood smear. We decided to perform a new medullary aspirate which depicted 73% blasts infiltrate (Figure 2). For a complete diagnosis, we also performed a cytogenetic exam (results not available at the moment) and imunophenotyping by flow cytometry. The flow cytometry revealed the presence of 20% blast with a phenotype suggestive for M1 FAB acute myeloid leukemia: SSC low, CD45 medium, CD34+, CD117+, HLA-DR+/-, cCD3-, CD3-, cCD79-, CD13+, CD11b-, CD36-, CD33+, CD64-, and CD56-. Thus, the progression of the disease was clear and the diagnosis of M1 FAB acute myeloid leukemia post-MDS with excess blasts type 2 was established.

Conclusions

Acute myeloid leukemia occurs in the evolution of MDS, especially in the high-risk types. The prognosis is particularly poor, considering the age, the comorbidities, the clonal evolution and the limited treatment options. We reported the appearance of a MDS case evolving in a full blown picture of acute leukemia in a very short period.  

Conflict of interests: The authors declare no con­flict of interests.

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