[Marked bone marrow necrosis preceding acute monoblastic leukemia]

Bone marrow necrosis is rarely diagnosed during life but is more often seen at autopsy by accident. The prognosis of patients with bone marrow necrosis secondary to neoplastic disease is extremely poor. We described a 53-year-old man with bone marrow necrosis preceding acute monoblastic leukemia. He was admitted in June, 1994, for continuous back pain and marked elevation of serum lactate dehydrogenase. After admission, a hematologic examination showed progressive pancytopenia in peripheral blood and bone marrow necrosis. He was diagnosed as AML (M5) from the sudden appearance of leukemic blasts in the peripheral blood two months later. Induction therapy was immediately administered according to JALSG-92 protocol. The patient suffered from tumor lysis syndrome after chemotherapy, but complete remission was achieved by dialysis.