Acute nonlymphocytic leukemia in malignant lymphoma.A morphologic study

Abstract

Ten patients who developed acute nonlymphocytic leukemia 29 to 132 months after a diagnosis of malignant lymphoma are described. Six of these patients had Hodgkin's disease, and four patients had non-Hodgkin's lymphoma. All received radiotherapy or chemotherapy, or both. A preleukemic period with peripheral blood and bone marrow changes was present in 6 patients. Nucleated red cells, macrocytosis and marked anisopoikilocytosis of red cells, and occasional myelocytes and promyelocytes were early changes in the peripheral blood in this group. Erythroid hyperplasia with megaloblastoid features, a mild to moderate shift toward granulocytic immaturity, increased numbers of megakaryocytes with cytologic abnormalities, and increased amounts of reticulin were found in the bone marrow. As overt myelogenous leukemia evolved, serial marrow studies in 5 of the 6 preleukemic patients showed a gradual increase in the numbers of blasts and in the amount of reticulin, a decrease in numbers of megakaryocytes, and a decrease in numbers of erythroid precursors. The sixth patient developed erythroleukemia. Two of the 10 patients had no apparent preleukemic phase, and information on two others was insufficient for a determination whether a preleukemic period existed. Cytochemical studies in all cases confirmed the nonlymphocytic nature of the leukemia.