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Erythrophagocytosis by leukaemic blasts—a poor prognostic feature—is mostly seen in acute myeloid leukaemia (AML), particularly monocytic leukaemia with cytogenetic abnormalities involving t(8;16)(p11;p13);MOZ-CBP or t(16;21)(p11;q22);FUS/TLS-ERG.1 This feature was reported in poorly differentiated leukaemias, including AML-M0, undifferentiated-type leukaemia and mixed lineage-type leukaemia, but very rarely in lineage-determined leukaemia, especially T-cell acute lymphoblastic leukaemia (T-ALL). We present a case of T-ALL with leukaemic blasts showing erythrophagocytosis, which was successfully treated with unrelated cord blood transplantation (uCBT).
A 11-year-old female child presented with prolonged abdominal distention of 1 month duration. Physical examination revealed both liver and spleen edges at 15 cm below the right and left costal margins, respectively. Abdominal X-ray showed a large mass with displaced intestines and MRI confirmed significant hepatosplenomegaly on low-intensity and high-intensity T1-enhanced and T2-enhanced images, respectively. There was no thymus enlargement. Laboratory examinations of peripheral blood showed the following: white blood cell count, 1.92×109/L with no leukaemic blasts; haemoglobin, 11.4 g/dL; platelet count, 80×109/L and serum lactate dehydrogenase, 541 IU/L. There was no serological evidence of Epstein-Barr virus or cytomegalovirus infection. Morphological evaluation of a bone marrow smear using May-Giemsa staining showed approximately 70% leukaemic blasts with irregular nuclear membranes, few nucleoli and scanty cytoplasm with some vacuoles, classified as L2 according to the French-American-British (FAB) classification; 4.8% of leukaemic blasts showed erythrophagocytosis (figure 1A–D). All blasts were negative for myeloperoxidase and double esterase staining. Immunophenotypic analysis of the surface markers revealed the leukaemic blasts to be positive for CD2, CD3, CD4, CD5, CD7, TCR α/β, cyCD3, CD117, CD58 and CD99 …