Journal of Cancer Research and Therapeutics

LETTER TO THE EDITOR
Year
: 2017  |  Volume : 13  |  Issue : 2  |  Page : 384-

Significant plasmacytosis in an early induction marrow of acute myeloid leukemia: Diagnostic and therapeutic implications


Namrata Punit Awasthi1, Sumaira Qayoom1, Ankita Jaiswal1, Sunil Dabadghao2,  
1 Department of Pathology, RMLIMS, Lucknow, Uttar Pradesh, India
2 Department of Hematology and Immunology, Sahara Hospital, Lucknow, Uttar Pradesh, India

Correspondence Address:
Sumaira Qayoom
Department of Pathology, RMLIMS, Lucknow, Uttar Pradesh
India




How to cite this article:
Awasthi NP, Qayoom S, Jaiswal A, Dabadghao S. Significant plasmacytosis in an early induction marrow of acute myeloid leukemia: Diagnostic and therapeutic implications.J Can Res Ther 2017;13:384-384


How to cite this URL:
Awasthi NP, Qayoom S, Jaiswal A, Dabadghao S. Significant plasmacytosis in an early induction marrow of acute myeloid leukemia: Diagnostic and therapeutic implications. J Can Res Ther [serial online] 2017 [cited 2022 Nov 27 ];13:384-384
Available from: https://www.cancerjournal.net/text.asp?2017/13/2/384/177498


Full Text

Sir,

Acute myeloid leukemia (AML) with reactive plasmacytosis is a known, yet rare entity.[1],[2] Their significant presence in an early induction marrow, where blasts and other hematopoietic elements are sparse can lead to a diagnostic dilemma of a coexistent plasma cell (PC) dyscrasia.[3]

We present here a case of a 58-year-old female patient, presenting with complaints of easy fatigability for the past 1 month. Physical examination revealed pallor along with hepatosplenomegaly. Complete blood counts with peripheral blood (PB) smear showed leukocytosis with the presence of 68% myeloperoxidase (MPO) positive blasts. Bone marrow aspiration showed 1% PC and 70% blasts which on flow cytometric immunophenotyping expressed CD34, CD117, CD13, CD33, and MPO; suggesting a diagnosis of an AML. The patient was administered standard 3 + 7 (cytarabine + daunorubicin) induction regime. PB on day 14 showed the presence of pancytopenia with mild rouleaux formation, but no circulating blasts. Bone marrow aspiration showed hypoplastic marrow with 2% blasts and a significant plasmacytosis (78% of nucleated cells) [Figure 1]. These PCs appeared mature in morphology and were found to be entrapped around the endothelial cells, suggesting their perivascular location and hence, a reactive nature. In view of the presence of peripheral rouleax, very high proportion of PCs, and known incidence of concomitant AML and PC dyscrasia,[4],[5] a myeloma workup was done, which also confirmed the reactive nature of PC [Figure 2]. A repeat bone marrow on day 30 showed normocellular marrow with trilineage hematopoiesis, with 1% blasts and 3% PC. Further course of the patient was uneventful, and she is in remission for the last 3 years.{Figure 1}{Figure 2}

Plasmacytosis seen in an early induction (day 14) marrow can be observed in some patients which is attributable to either some prior/concomitant infection or to the paracrine stimulation by the blasts mediated by cytokine interleukin-6 (IL-6).[1] One large study, which included 60 AML patients, showed the proportion of PC s to be 0.1–48.7%, and 15 (25%) patients to be having evidence of an antecedent or concomitant infection.[2] They also noted that mean PC proportion in cases having infection was significantly higher as compared to those who do not have any evidence of infection (18.1% vs. 10.7%, P= 0.039). Majority of the cases in this study were M4/M5 (50%) and were expected to be associated with increased IL-6 production and consequently plasmacytosis. In contrast, the present case neither had any clinical/laboratory evidence of infection nor had morphological evidence of monocytic differentiation. A proportion as high as 78%, as noted in our case, has never been reported. These cases with such a high PC proportion can very well masquerade as coexistent PC dyscrasias.[3] It is hypothesized that postinduction plasmacytosis may have an immunological role in maintaining remission. This was demonstrated in the study by Al-Shughair et al.[2] where the responders had higher PC proportion (14.3%) as compared with nonresponders (4.6%), predicting the likelihood of being free from leukemia. Similarly, the present case is also responding well and is in remission for the last 3 years. However, more studies are required to validate the clinical significance of this hypothesis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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