Acute monoblastic leukemia: a clinical and biologic study of 74 cases.

The authors have performed a clinical and statistical analysis of the presenting features of adult acute leukemia classified according to the French-American-British (FAB) hematopathologic criteria. Observations were made on 70 variables of history, physical examination, and laboratory examination recorded for 195 patients seen during a recent six year interval. The incidence of each category as determined by consensus of three observers was L1, 9%; L2, 17%; L3, 3%; M1, 21%; M2, 22%; M3, 5%; M4, 21%; M5, 4%; and M6 1%. there were recurring features of each FAB category and for aggregated categories (myeloid, lymphoid). Some groups such as L1, M3, M4, and M5 were characterized by many distinctive characteristics. In contrast, the L2, M1, and M2 categories had few distinctive characteristics, although L3 shared many features with the other lymphoid groups. The distinctness of the categories was quantitated by stepwise discriminant analysis. Using only a few computer-selected clinical variables, the authors classified patients into the correct FAB category with an accuracy of over 65% for some groups. The accuracy in discriminating between lymphoid and myeloid groups, the important therapeutic distinction, was 82%. This study demonstrates that many of the categories defined by the FAB criteria have characteristic clinical features at presentation.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/1097-0142%2819810515%2947%3A10%3C2460%3A%3AAID-CNCR2820471025%3E3.0.CO%3B2-4

Analysis of the presenting features of adult acute leukemia: the French-American-British classification.

Seventy-four cases of pure acute monoblastic leukemia (AMol) have been retrospectively studied. All patients were treated at Hospital Saint-Louis between 1970 and 1978. Diagnosis was based on morphological and cytochemical features according to the FAB classification. This type of leukemia occurred at any age and in both sexes, with a high frequency of extramedullary involvements. Hyperleukocytosis was very frequent and was significantly correlated with increased blood and urine levels of lysozyme, with renal failure and hypokalemia, and with coagulation abnormalities. AMol still has a poor prognosis, despite a best remission rate (75%) obtained with rubidazone, since the duration of complete remission was short. Central nervous irradiation prolonged remission and prevented meningeal relapses, while 6 meningeal relapses occurred in the patients not irradiated. The high frequency of the extramedullary relapses, including gum and skin, emphasized the question of persistant blast cell sanctuaries after achievement of bone marrow remissions. A more intensive induction with several drugs active against monoblasts could be more efficient and prolong the duration of complete remissions.

A Clinical and Biologic Study of 74 Cases

The clinical and pathologic features of eight infants with monocytic leukemia are reviewed. The children were all aged 12 months or less at diagnosis and had a high incidence of extramedullary features, skin infiltration being particularly common. The diagnosis was established by conventional morphologic and cytochemical techniques. Using the French-American-British (FAB) classification, five infants had FAB 5a disease, and three had FAB 5b. The difficulties in making the diagnosis from extramedullary sites and the overlap that exists at this age between monocytic leukemia, true histiocytic lymphoma, and malignant histiocytosis are discussed. The treatments given to the group and their response are reviewed. Five of the patients received VP-16-213 and cyclophosphamide as primary induction chemotherapy, a combination that merits further evaluation in leukemia with monocytic features.

Monocytic leukemia in infancy. A review of eight children.

Background: Oral findings in acute leukemia (AL) are common and could be the presenting feature of the disease, namely, gingival enlargement, ulceration, bleeding, and infection. Gingival enlargement in AL is either due to leukemic infiltration, or due to reactive hyperplasia. To differentiate between them a biopsy is required, but being highly contraindicated, biopsy has been substituted in this study by fine needle aspiration cytology (FNAC).



Method:  Gingival FNAC was performed on different sites in the upper and lower gingiva. Each site represents an interdental papilla, which was selected according to the clinical presentation, i.e., being enlarged or not. Seventy-two adult AL patients received a cytological and clinical examination in this study, and the cases were classified and categorized according to the French-American-British (FAB) criteria.



Results:  Twenty-one cases were diagnosed as being infiltrated, 16 with gingival enlargement, 4 with no evidence of enlargement. In one case the infiltration affected the alveolar mucosa of an edentulous patient. In six cases the ginigva was enlarged without being infiltrated (reactive hyperplasia). Leukemic gingival enlargement was seen mostly in patients with acute myeloid leukemia, particularly M4 and M5 subtypes; however, two patients with acute mixed lineage leukemia (AMLL) were both affected with leukemic infiltration.



Conclusion:  FNAC was shown to be a simple, non-traumatic and useful diagnostic procedure for screening leukemic infiltration in gingival tissues in AL patients.

Gingival fine needle aspiration cytology in acute leukemia

Twelve cases of pure acute monocytic leukemia in adults were studied. They were selected on the basis of the morphology of the blast cells on Romanowsky-stained smears of blood and bone marrow, as well as positivity of the cells for the naphthol ASD acetate esterase reaction specifically inhibited by sodium fluoride. There was no sex predominance. Neoplastic involvement of the skin and/or gingiva was very frequent. The leukemic proliferation in blood and bone marrow consisted of monoblasts, promonocytes and monocytes. The peroxidase reaction was negative or only faintly positive. Serum and urinary lysozyme levels were increased. The blast cells retained their ability to stimulate, in vitro , colony formation by normal bone marrow cells used as targets. All of these characteristics permit specific identification of this type of acute leukemia. The prognosis is grim: only five of 12 patients achieved complete remission, and four of these five had relapses in less than 14 months; the median survival was five months.

Pure acute monocytic leukemia. A study of 12 cases.

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Pure acute monocytic leukemia. A study of 12 cases.