Acute nonlymphocytic leukemia in patients with nodular lymphoma

Acute nonlymphocytic leukemia (ANLL) developed in four patients 66 to 157 months following the diagnosis of nodular poorly differentiated lymphocytic lymphoma (PDL-N). The ANLL was signalled by increasing anemia and thrombocytopenia. A characteristic cytologic pattern of the leukemia was found. In each patient, a panmyelosis was present with striking morphologic abnormalities in leukocytes, erythrocytes and megakaryocytes. Marrow cytogenetic studies demonstrated abnormalities in all three patients studied. One of three patients treated with intensive chemotherapy obtained a complete remission. When long term survivors with PDL-N develop increasing anemia and thrombocytopenia, morphologic and cytogenetic marrow examinations are indicated to distinguish progressive lymphoma from therapy-induced myelosuppression or ANLL.