Hypocellular Acute Myeloid Leukemia

Hypocellular AML is a diagnostic dilemma. It does not fit the FAB classification of acute leukemia and often is mistaken for myelodysplasia or even aplastic anemia.144,145 In general these patients are elderly, most having long-standing hematological complaints before diagnosis and lacking physical findings. Most of them are leukopenic or pancytopenic and have few blasts in the peripheral blood. The bone marrow is hypocellular, with more than 30 percent poorly differentiated type I blasts. The incidence of hypocellular leukemia is reported to be 8 to 14 per-cent.144-147 According to most investigators, a case of acute leukemia is considered hypocellular when the bone marrow cel-lularity is less than 30 percent.146,147 However, since most patients are elderly and have low cellularity because of age, the cutoff value of bone marrow cellularity is controversial. In a study conducted in our laboratory,146 bone marrow cellularity of 40 percent would seem to present the upper limit to include such cases into hypocellular AML for clinical comparisons. Recent studies146,147 revealed that hypocellular AML was a distinct subtype of AML characterized by slow but distinct proliferation of immature blasts. Although most cases had blasts with low or negative MPO activity, immunophenotyping of blast cells showed expression of myeloid antigens. Dysplastic changes were present. In one study147 karyotyping revealed nonrandom chromosome abnormalities that are considerably different from those seen in MDS.

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