[An adult case of acute lymphoblastic leukemia preceded by aplasia resembling aplastic anemia]

Although aplastic anemia (AA) is well known to precede acute leukemia, commonly acute myeloblastic leukemia, an adult case of acute lymphoblastic leukemia (ALL) preceded by aplasia similar to severe AA is very rare. An 18-year-old female was admitted to our hospital for scrutiny of pancytopenia in October 3, 1991. She was diagnosed as severe AA because of severe bone marrow hypoplasia and no abnormal or dysplastic cell. Recovery of hematopoiesis was achieved by pulse therapy of methylprednisolone combined with granulocyte colony stimulating factor (G-CSF). 3 months after AA onset, she was readmitted because of high fever and paralytic ileus. Then, she was diagnosed as ALL (L1; common ALL) and was successfully treated by remission induction chemotherapy. Retrospectively, this case was atypical AA with respect to serum iron and LDH level.