Therapy related acute myeloid leukemia with blast cannibalism and cytophagocytosis

The case of an 83-year old male patient is described. He presented to our hospital with a 2 week history of intermittent syncope and was diagnosed with atrial fibrillation. His CBC showed bicytopenia with anemia and neutropenia in context of a leucoerythroblastic blood film and blastemia. As the patient was previously diagnosed with stage IV diffuse large B cell lymphoma; treated with CHOP-R a bone marrow biopsy was requested to rule out acute leukemia. A cellular bone marrow aspirate showed presence of a myeloblast infiltrate (32.6%; confirmed by flow cytometry). Interestingly blast phagocytosis of terminally differentiated cells along with cannibalism of other blasts was identified. The diagnosis of therapy-related acute myeloid leukemia was reached and a palliative consultation was requested. To our knowledge, this is the first report of blast cytophagocytosis and cannibalism associated with a therapy-related acute myeloid leukemia with a complex karyotype.