Osteolytic lesions as a presenting sign of acute nonlymphocytic leukemia

Osteolytic lesions occur rarely in acute leukemia, especially in adults. We describe a patient with chronic myelomonocytic leukemia, in whom multiple osteolytic lesions were the presenting sign of the transformation into acute leukemia. Local irradiation to a painful lesion in the left hip resulted in transient but significant symptomatic relief with improved quality of life. We conclude that osteolytic lesions, although rare in adult acute leukemia, indicate an advanced disease state, but may respond to palliative local irradiation.