Acute lymphoblastic leukemia: hand mirror variant

The presence of numerous hand mirror cells in the bone marrow of patients with acute leukemia may be related to a good prognosis. To further evaluate this relationship, the bone marrows of 21 consecutive patients with a diagnosis of acute lymphoblastic leukemia were reviewed for the presence of greater than 40% hand mirror cells. Four of these 21 patients (19%) demonstrated this finding during the course of their illness. These patients were characterized by ease of remission and/or prolonged survival. Three (75%) patients are alive and well at the time of this writing. At the present time, of the 17 patients without hand mirror cells, seven (41%) are alive and ten (59%) are dead. Although not statistically significant, our findings suggest a positive relationship between the presence of greater than 40% hand mirror cells in the bone marrow ans a favorable prognosis. Future larger prospective studies are indicated to further understand the importance of this complex, apparently immunologically stimulated cell.