Agnogenic myeloid metaplasia with pleural extramedullary leukemic transformation

Hassan F. Nadrous, Michael Joseph Krowka, Rebecca F. McClure, Ayalew Tefferi, Kaiser G. Lim

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Agnogenic myeloid metaplasia (AMM) is one of the myeloproliferative disorders, and is usually accompanied by extramedullary hematopoiesis (EMH) in various organs, mainly in the liver, spleen and lymph nodes. Extramedullary hematopoiesis and/or leukemic transformation of EMH in the pleura is a rare occurrence and is usually asymptomatic. Pleural involvement is usually diagnosed on postmortem examination. Herein we describe a 71-year-old man with newly diagnosed agnogenic myeloid metaplasia who was evaluated for progressively worsening dyspnea, pulmonary hypertension and bilateral pleural effusions. EMH involving the lungs and pleura was suspected. A sulfur colloid technetium 99m bone marrow scan performed to detect extramedullary hematopoiesis was negative. The diagnostic thoracentesis yielded bloody fluid that contained a large population of myeloblasts, indicating pleural leukemic transformation. The patient received 100 cGy to the whole lung for treatment of pulmonary hypertension due to EMH. This was followed by 1500 cGy total dose of radiation to the left lung for pleural extramedullary leukemic transformation. Pleural effusions resolved and repeat echocardiography showed reduction of the pulmonary artery pressure. Three months later he had leukemic transformation involving the skin and lymph nodes. Four months after radiation therapy, he had full-blown acute myeloid leukemia. He received 2 cycles of Gemtuzumab ozogamicin (MylotargR), allopurinol and hydroxyurea. Three months after initiation of chemotherapy, he deteriorated and received salvage chemotherapy of prednisone, VP-16 and imatinib mesylate (GleevecR). He was hospitalized for neutropenic fever and was diagnosed to have pulmonary aspergillosis. He died of multisystem failure 8 1/2 months after being diagnosed with AMM.

Original languageEnglish (US)
Pages (from-to)815-818
Number of pages4
JournalLeukemia and Lymphoma
Volume45
Issue number4
DOIs
StatePublished - Apr 2004

Fingerprint

Extramedullary Hematopoiesis
Primary Myelofibrosis
Pleura
Pleural Effusion
Pulmonary Hypertension
Lung
Lymph Nodes
Pulmonary Aspergillosis
Drug Therapy
Granulocyte Precursor Cells
Myeloproliferative Disorders
Allopurinol
Hydroxyurea
Technetium
Colloids
Etoposide
Prednisone
Sulfur
Acute Myeloid Leukemia
Dyspnea

Keywords

  • Agnogenic myeloid metaplasia
  • Extramedullary hematopoiesis
  • Leukemia
  • Pulmonary hypertension

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

Agnogenic myeloid metaplasia with pleural extramedullary leukemic transformation. / Nadrous, Hassan F.; Krowka, Michael Joseph; McClure, Rebecca F.; Tefferi, Ayalew; Lim, Kaiser G.

In: Leukemia and Lymphoma, Vol. 45, No. 4, 04.2004, p. 815-818.

Research output: Contribution to journalArticle

Nadrous, Hassan F. ; Krowka, Michael Joseph ; McClure, Rebecca F. ; Tefferi, Ayalew ; Lim, Kaiser G. / Agnogenic myeloid metaplasia with pleural extramedullary leukemic transformation. In: Leukemia and Lymphoma. 2004 ; Vol. 45, No. 4. pp. 815-818.
@article{dd693b170689490391e80a65cf1144ee,
title = "Agnogenic myeloid metaplasia with pleural extramedullary leukemic transformation",
abstract = "Agnogenic myeloid metaplasia (AMM) is one of the myeloproliferative disorders, and is usually accompanied by extramedullary hematopoiesis (EMH) in various organs, mainly in the liver, spleen and lymph nodes. Extramedullary hematopoiesis and/or leukemic transformation of EMH in the pleura is a rare occurrence and is usually asymptomatic. Pleural involvement is usually diagnosed on postmortem examination. Herein we describe a 71-year-old man with newly diagnosed agnogenic myeloid metaplasia who was evaluated for progressively worsening dyspnea, pulmonary hypertension and bilateral pleural effusions. EMH involving the lungs and pleura was suspected. A sulfur colloid technetium 99m bone marrow scan performed to detect extramedullary hematopoiesis was negative. The diagnostic thoracentesis yielded bloody fluid that contained a large population of myeloblasts, indicating pleural leukemic transformation. The patient received 100 cGy to the whole lung for treatment of pulmonary hypertension due to EMH. This was followed by 1500 cGy total dose of radiation to the left lung for pleural extramedullary leukemic transformation. Pleural effusions resolved and repeat echocardiography showed reduction of the pulmonary artery pressure. Three months later he had leukemic transformation involving the skin and lymph nodes. Four months after radiation therapy, he had full-blown acute myeloid leukemia. He received 2 cycles of Gemtuzumab ozogamicin (MylotargR), allopurinol and hydroxyurea. Three months after initiation of chemotherapy, he deteriorated and received salvage chemotherapy of prednisone, VP-16 and imatinib mesylate (GleevecR). He was hospitalized for neutropenic fever and was diagnosed to have pulmonary aspergillosis. He died of multisystem failure 8 1/2 months after being diagnosed with AMM.",
keywords = "Agnogenic myeloid metaplasia, Extramedullary hematopoiesis, Leukemia, Pulmonary hypertension",
author = "Nadrous, {Hassan F.} and Krowka, {Michael Joseph} and McClure, {Rebecca F.} and Ayalew Tefferi and Lim, {Kaiser G.}",
year = "2004",
month = "4",
doi = "10.1080/1042819032000141329",
language = "English (US)",
volume = "45",
pages = "815--818",
journal = "Leukemia and Lymphoma",
issn = "1042-8194",
publisher = "Informa Healthcare",
number = "4",

}

TY - JOUR

T1 - Agnogenic myeloid metaplasia with pleural extramedullary leukemic transformation

AU - Nadrous, Hassan F.

AU - Krowka, Michael Joseph

AU - McClure, Rebecca F.

AU - Tefferi, Ayalew

AU - Lim, Kaiser G.

PY - 2004/4

Y1 - 2004/4

N2 - Agnogenic myeloid metaplasia (AMM) is one of the myeloproliferative disorders, and is usually accompanied by extramedullary hematopoiesis (EMH) in various organs, mainly in the liver, spleen and lymph nodes. Extramedullary hematopoiesis and/or leukemic transformation of EMH in the pleura is a rare occurrence and is usually asymptomatic. Pleural involvement is usually diagnosed on postmortem examination. Herein we describe a 71-year-old man with newly diagnosed agnogenic myeloid metaplasia who was evaluated for progressively worsening dyspnea, pulmonary hypertension and bilateral pleural effusions. EMH involving the lungs and pleura was suspected. A sulfur colloid technetium 99m bone marrow scan performed to detect extramedullary hematopoiesis was negative. The diagnostic thoracentesis yielded bloody fluid that contained a large population of myeloblasts, indicating pleural leukemic transformation. The patient received 100 cGy to the whole lung for treatment of pulmonary hypertension due to EMH. This was followed by 1500 cGy total dose of radiation to the left lung for pleural extramedullary leukemic transformation. Pleural effusions resolved and repeat echocardiography showed reduction of the pulmonary artery pressure. Three months later he had leukemic transformation involving the skin and lymph nodes. Four months after radiation therapy, he had full-blown acute myeloid leukemia. He received 2 cycles of Gemtuzumab ozogamicin (MylotargR), allopurinol and hydroxyurea. Three months after initiation of chemotherapy, he deteriorated and received salvage chemotherapy of prednisone, VP-16 and imatinib mesylate (GleevecR). He was hospitalized for neutropenic fever and was diagnosed to have pulmonary aspergillosis. He died of multisystem failure 8 1/2 months after being diagnosed with AMM.

AB - Agnogenic myeloid metaplasia (AMM) is one of the myeloproliferative disorders, and is usually accompanied by extramedullary hematopoiesis (EMH) in various organs, mainly in the liver, spleen and lymph nodes. Extramedullary hematopoiesis and/or leukemic transformation of EMH in the pleura is a rare occurrence and is usually asymptomatic. Pleural involvement is usually diagnosed on postmortem examination. Herein we describe a 71-year-old man with newly diagnosed agnogenic myeloid metaplasia who was evaluated for progressively worsening dyspnea, pulmonary hypertension and bilateral pleural effusions. EMH involving the lungs and pleura was suspected. A sulfur colloid technetium 99m bone marrow scan performed to detect extramedullary hematopoiesis was negative. The diagnostic thoracentesis yielded bloody fluid that contained a large population of myeloblasts, indicating pleural leukemic transformation. The patient received 100 cGy to the whole lung for treatment of pulmonary hypertension due to EMH. This was followed by 1500 cGy total dose of radiation to the left lung for pleural extramedullary leukemic transformation. Pleural effusions resolved and repeat echocardiography showed reduction of the pulmonary artery pressure. Three months later he had leukemic transformation involving the skin and lymph nodes. Four months after radiation therapy, he had full-blown acute myeloid leukemia. He received 2 cycles of Gemtuzumab ozogamicin (MylotargR), allopurinol and hydroxyurea. Three months after initiation of chemotherapy, he deteriorated and received salvage chemotherapy of prednisone, VP-16 and imatinib mesylate (GleevecR). He was hospitalized for neutropenic fever and was diagnosed to have pulmonary aspergillosis. He died of multisystem failure 8 1/2 months after being diagnosed with AMM.

KW - Agnogenic myeloid metaplasia

KW - Extramedullary hematopoiesis

KW - Leukemia

KW - Pulmonary hypertension

UR - http://www.scopus.com/inward/record.url?scp=1342266130&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=1342266130&partnerID=8YFLogxK

U2 - 10.1080/1042819032000141329

DO - 10.1080/1042819032000141329

M3 - Article

VL - 45

SP - 815

EP - 818

JO - Leukemia and Lymphoma

JF - Leukemia and Lymphoma

SN - 1042-8194

IS - 4

ER -