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Transformation of CMML to AML presenting with acute kidney injury

Rebecca DeBoer1, Ian Garrahy1, Andrew Rettew1

  • 1Department of Medicine, Reading Hospital, Reading, PA, USA.

Journal of Community Hospital Internal Medicine Perspectives
|August 28, 2020
PubMed

Insights

Chronic myelomonocytic leukemia (CMML) can progress to acute myeloid leukemia (AML). Progressive renal insufficiency and hyperuricemia in CMML patients suggest AML transformation, which may be reversible with treatment.

Area of Science:

  • Hematology
  • Oncology
  • Nephrology

Background:

  • Chronic myelomonocytic leukemia (CMML) is an aggressive myeloid neoplasm characterized by bone marrow dysplasia and peripheral blood monocytosis.
  • CMML has a significant risk of transforming into acute myeloid leukemia (AML), a more aggressive hematologic malignancy.
  • Acute myeloid leukemia (AML) often presents with complications of pancytopenia or renal insufficiency.

Observation:

  • A 79-year-old male with a history of CMML and stage 3 chronic kidney disease presented with acute anuria, unintentional weight loss, fatigue, and bone pain.
  • Laboratory findings included marked leukocytosis with monocytosis, elevated creatinine, hyperuricemia, and hypoalbuminemia.
  • Bone marrow biopsy confirmed acute myeloid leukemia with monocytic differentiation, and imaging revealed splenomegaly and lymphadenopathy.

Findings:

  • The patient's presentation of acute kidney injury, hyperuricemia, and bone pain in the context of CMML was indicative of progression to acute myeloid leukemia.
  • The bone marrow biopsy confirmed AML with monocytic features, supporting the clinical suspicion.
  • Imaging studies identified extramedullary disease, including splenomegaly and lymphadenopathy.

Implications:

  • Progressive renal insufficiency and hyperuricemia in CMML patients warrant a high index of suspicion for AML transformation.
  • Early recognition and treatment of AML in CMML patients can lead to potentially reversible kidney failure.
  • This case highlights the importance of monitoring renal function and uric acid levels in CMML patients to detect disease progression.
Keywords:
Acute myeloid leukemiaacute kidney injurychronic myelomonocytic leukemiahyperuricemialysozymuria

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