To early distinguish neonatal transient leukemoid proliferation from congenital leukemia by in vitro cell growth

To differentiate neonatal transient leukemoid proliferation from congenital leukemia at an early stage is often difficult. Bone marrow culture is found to be helpful in this aspect. A normal in vitro growth pattern suggests transient leukemoid proliferation, while an abnormal growth pattern indicates congenital leukemia. A neonate who manifested with pictures mimicking acute myeloblastic leukemia (M1), had a karyotype of 46, XY/46, XY, i(21 q). However, the in vitro growth pattern was normal and so only supportive treatment was given. All the leukemoid manifestations disappeared several months later and he is now a healthy 2 year old boy remaining in complete remission. A second neonate who also displayed features of acute myeloblastic leukemia (M2), had a karyotype of 46, XY/47, XY, + 21 and abnormal in vitro growth pattern. This neonate died at 18 days of age.