A 62-year-old woman was seen in the emergency room for fatigue. On examination, she was found to have lymphadenopathy affecting the anterior cervical, axillary, and inguinal areas. She also had non-tender hepatosplenomegaly. Complete blood count revealed a hemoglobin of 76 g/L, platelets 99 × 109/L, and severe leukocytosis (297 × 109/L). The differential showed 90% blasts (blood smear shown).
The peripheral smear and the bone marrow blasts were intermediate to large in size, with some prominent nucleoli; 10% were myeloperoxidase positive. Myeloid maturation was also present in a few blasts. Flow cytometry affirmed an abnormal immature myeloid population. Probes for BCR-ABL were negative.
The patient received emergent leukopheresis in the emergency room. A diagnosis of blast crises secondary to acute myeloid leukemia without maturation (French-American-British classification AML-M1) was made. She was started on chemotherapy, initially with Ara-C and mitoxantrone, and later switched to decitabine. The patient responded well to the treatment.
