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Acute myeloid leukemia with near-triploid karyotype and extramedullary involvement of mediastinum

Bone Marrow Transplantation volume 36, page 1107 (2005)Cite this article

A 22-year-old man presented with dyspnea and left chest pain in November 2003. Complete blood counts revealed WBC: 18.2 × 109/l (35% blasts, 31% neutrophils), hemoglobin 119 g/l and platelets 166 × 109/l. CT scan showed extensive mediastinal lymphadenopathy, left sided pleural effusion (cytologically malignant) and a pericardial effusion. Lymph node biopsy was first interpreted as high-grade lymphoma after conventional stains. However, bone-marrow cytology demonstrated 85% infiltration with basophil blasts with intermediate size (15% with peroxidase-positive granulation). Lymph node immunohistology, flow cytometry and bone-marrow histology confirmed acute myeloid leukemia (AML). The blasts coexpressed CD56. Chromosome analysis revealed a near-triploid karyotype (64 XY, −X, −1, −2, −7, −16).

The patient received induction chemotherapy (two cycles standard-dose cytarabine, idarubicin and etoposide, trial: AML-HD98A). In the bone marrow, partial remission was achieved after the first and complete remission after the second cycle. Mediastinal lymph nodes and effusions decreased markedly but didnot resolve. Immediately before consolidation therapy, mediastinal lymph nodes enlarged again. Inferior vena cava syndrome and renal function impairment developed. Since these symptoms improved rapidly during consolidation therapy with high-dose cytarabine and mitoxantrone they were interpreted as signs of disease progression. In April 2004, allogeneic stem-cell-transplantation (allo-SCT) from a nonrelated donor after conditioning with total body irradiation (8 Gy), thiotepa and fludarabine was performed. Graft-versus-host disease (GvHD) prophylaxis included cyclosporine A and methotrexate, although moderate GvHD involving the liver developed.

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Authors and Affiliations

  1. Medizinische Klinik und Poliklinik I, Universität Bonn, Germany

    M Gorschlüter, U Mey, A Glasmacher & I G H Schmidt-Wolf

  2. Deutsche Klinik für Diagnostik, Wiesbaden, Germany

    R Schwerdtfeger

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  1. M Gorschlüter
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  2. U Mey
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  3. A Glasmacher
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  4. R Schwerdtfeger
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  5. I G H Schmidt-Wolf
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Gorschlüter, M., Mey, U., Glasmacher, A. et al. Acute myeloid leukemia with near-triploid karyotype and extramedullary involvement of mediastinum. Bone Marrow Transplant 36, 1107 (2005). https://doi.org/10.1038/sj.bmt.1705163

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