[Myeloid/natural killer cell acute leukemia resembling acute promyelocytic leukemia]
Jian-Ning Wang1, Yan-Qiu Hou, Liu-Bo Zhang
1Department of Hematology, Nanjing Medical University Second Hospital, Nanjing 210011, Jiangsu Province, China (E-mail: wangjn6@126.com).
Insights
This study reports a rare case of myeloid/natural killer cell acute leukemia that mimics acute promyelocytic leukemia (APL). Distinguishing this leukemia is crucial for appropriate treatment with chemotherapy.
Area of Science:
- Hematology
- Oncology
- Molecular Biology
Background:
- Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia.
- Accurate diagnosis of APL is critical due to its unique treatment response and prognosis.
- Myeloid/natural killer cell acute leukemia is a rare entity that can present with overlapping features with APL.
Observation:
- A patient presented with clinical and morphological features resembling APL, including anemia, thrombocytopenia, and leukocytosis.
- Leukemia cells showed abnormal morphology similar to APL M3v.
- Immunophenotypic analysis revealed expression of myeloid and NK cell markers (CD117, CD33, CD15, CD56) but lacked typical APL markers.
Findings:
- Genetic analysis excluded the characteristic t(15;17) translocation and PML/RARα fusion gene found in APL.
- The patient did not respond to all-trans retinoic acid (ATRA), a standard APL treatment.
- Abnormal cytogenetics with del(7)(q22q32) was identified.
Implications:
- Accurate differentiation between myeloid/natural killer cell acute leukemia and APL is essential for effective treatment.
- This rare leukemia should be treated with standard chemotherapy regimens for acute myeloid leukemia.
- Further research is needed to understand the biology and optimal treatment strategies for this rare leukemia.
Abstract:
In order to improve the recognition of myeloid/natural killer cell acute leukemia and to reduce misdiagnosis, one case of myeloid/natural killer cell acute leukemia resembling acute promyelocytic leukemia(APL) was reported and the related articles published were reviewed. A series of clinical tests, the morphologic and immunophenotypic analysis of leukemia cells, cytogenetic and molecular biological examinations were performed. The results indicated that the patient had anemia, thrombocytopenia and leucocytosis, but no evidence of lymphadenopathy and hepatosplenomegaly. The morphology of leukemia cells was similar to that of abnormal promyelocytic cells, especially the variant of M3 (M3v) leukemia cells. The leukemia cells expressed CD117, CD33, CD15, CD56 and cMPO, but did not express CD34, HLA-DR, CD13 and CD16. Abnormal cytogenetics with del (7) (q22q32) was found. Neither t(15;17) nor PML/RARα gene rearrangement was detected. The patient failed to show a differentiation-induction response to all-trans retinoic acid(ATRA). In conclusion, the myeloid/natural killer cell leukemia is extremely rare. It is very important to distinguish the disorder from APL/M3v. The patient with myeloid/natural kill cell acute leukemia should be treated with chemotherapy as acute myeloid leukemia.
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