Myeloid leukemoid reaction after initial azacitidine therapy for chronic myelomonocytic leukemia.
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| Abstract |
The development of myeloid leukocytosis in leukemia patients during antileukemic treatment requires a differential diagnosis between myeloid leukemoid reaction and leukemia progression. We herein report the case of an 80-year-old Japanese man with chronic myelomonocytic leukemia (CMML) who developed marked myeloid leukocytosis (36.3 × 109/L) with 32.5% monocytes and 48% neutrophils about 4 weeks after the initial 5-azacitidine (AZA) treatment. The leukocytosis was unlikely to be attributed to infection and adverse drug reaction. As it resolved in a few days without any interventions, the transient myeloid leukocytosis was confirmed to be a myeloid leukemoid reaction. After four cycles of AZA treatment, leukemic blasts in the bone marrow decreased and the patient became transfusion-independent. Interestingly, levels of serum G-CSF showed a similar trend to the myeloid leukocytosis, while those of serum GM-CSF and IL-17 were undetectable throughout the clinical course, suggesting that a differentiation response to AZA treatment might lead to the myeloid leukemoid reaction. Our case implies that a marked but transient myeloid leukemoid reaction mimicking CMML progression can develop during AZA treatment, which requires careful clinical monitoring and differential diagnosis.
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| Authors | Takeshi Hagino, Tomohiko Sato, Reina Saga, Hiroko Hidai, Yoshiro Murai, Hideki Akiyama, Sayuri Motomura |
| Journal | International journal of hematology (Int J Hematol) Vol. 116 Issue 6 Pg. 961-965 (Dec 2022) ISSN: 1865-3774 [Electronic] Japan |
| PMID | 35852697 (Publication Type: Case Reports, Journal Article) |
| Copyright | © 2022. Japanese Society of Hematology. |
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