Osteolytic bone lesions as an initial presenting manifestation of adult acute lymphoblastic leukemia: a mini review

Hematological malignancies can lead to bone lesions, and the most common example is the osteolytic lesions found in multiple myeloma. Cases of osteolytic lesions have been rarely reported in acute lymphoblastic leukemia (ALL), non-Hodgkin lymphoma, Waldenström macroglobulinemia, chronic lymphocytic leukemia, acute myeloid leukemia, and myeloproliferative neoplasms. This review sheds light on the association between ALL and osteolytic bone lesions. To our knowledge, we found 15 cases of patients with ALL who developed osteolytic lesions. Most patients were males with a median age of 29 years. B-cell ALL was the most common type of ALL associated with osteolytic lesions. All patients presented with bone pain, and hypercalcemia was found in 80% of the reported cases. Osteolytic lesions were detected by plain radiography (X-ray) in approximately half of the patients; computed tomography, MRI, or PET scans confirmed the osteolytic lesions in the remaining patients. The axial skeleton was mainly affected. Based on our review, there was no association between osteolytic bone lesions and the Philadelphia chromosome. There are no case of spinal cord compression in adults ALL patients attributed to osteolytic lesions of the vertebra. The majority of patients received chemotherapy, and the outcomes among these patients were variable. Almost all of them achieved complete remission. However, two patients developed a disease relapse. Given that our review is solely based on case reports, we could not conclude if the presence of osteolytic bone lesions is a prognostic factor for adverse outcomes or indicates an 'aggressive' form of ALL.