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Pseudorelapse in acute myelomonocytic leukemia after high dose methylprednisolone
1Department of Pediatric Hematology, Medical Faculty of Ondokuzmayis University, Samsun, Turkey.
Abstract:
High dose methylprednisolone (HDMP) has been used in induction treatment and in leukopenia of acute leukemia. We report the case of a 14-year-old girl with acute myelomonocytic leukemia (AMML) who developed a pseudorelapse after receiving an oral HDMP trial (30 mg/kg/day PO in the morning for 15 days) to overcome neutropenia. She presented with severe bone pain at the end of treatment. Bone marrow examination revealed 53% young promyelocytes (some with a large nucleolus), 2% myeloblast, 5% monocyte, and increased cellularity. Bone pain and promyelocytes regressed spontaneously while maintenance treatment continues. We advise that a pseudorelapse must be borne in mind after HDMP and probably GM-CSF treatments in acute leukaemias.
Insights
High dose methylprednisolone (HDMP) can cause pseudorelapse in acute leukemia patients. This case highlights the need to consider pseudorelapse after HDMP and GM-CSF treatments.
Area of Science:
- Hematology
- Oncology
- Pharmacology
Background:
- High-dose methylprednisolone (HDMP) is utilized in acute leukemia induction and to manage neutropenia.
- Acute myelomonocytic leukemia (AMML) is a subtype of acute leukemia requiring specific treatment protocols.
Observation:
- A 14-year-old girl with AMML received an oral HDMP trial to address neutropenia.
- The patient experienced severe bone pain and bone marrow findings suggestive of relapse at the end of the HDMP treatment.
Findings:
- Bone marrow examination revealed a significant increase in young promyelocytes (53%), myeloblasts (2%), and monocytes (5%) with increased cellularity.
- The patient's bone pain and elevated promyelocyte counts spontaneously resolved during maintenance therapy.
Implications:
- This case suggests that HDMP can induce a pseudorelapse in acute leukemia patients.
- Clinicians should consider pseudorelapse in the differential diagnosis for patients with acute leukemia experiencing symptoms after HDMP or granulocyte-macrophage colony-stimulating factor (GM-CSF) treatment.