Hemophagocytosis in acute myeloid leukemia

A 63-year-old man with acute myeloid leukemia (AML) and treated with venetoclax and azacytidine, presented to the emergency department with fever, shortness of breath and gum bleeding. Laboratory evaluation showed pancytopenia; prolonged thrombin time with hypofibrinogenemia, elevated D-dimer and hyperferritinemia (29,000 µg/ L). Bone marrow smear revealed blastic infiltration with hemophagocytosis by histiocytes (panel A), macrophages (Panel B) and blasts (Panels C and D), (Figure 1).

Figure 1
Bone marrow aspirate showing hemophagocytosis by (A) histiocytes, (B) macrophages and (C, D) infiltration with hemophagocytosis by monocytic blasts (Wright-Giemsa stain, 100x).

Salvage chemotherapy was initiated, but the patient died 28 days after presentation. Hemophagocytic lymphohistiocytosis can be diagnosed in up to 10% of patients with AML,¹ and is associated with poor outcomes.¹,²

References

• ¹
  Delavigne K., Bérard E., Bertoli S., Corre J., Duchayne E., Demur C., et al. Hemophagocytic syndrome in patients with acute myeloid leukemia undergoing intensive chemotherapy. Haematologica. 2014;99(3):474-80.
• ²
  Hatano K., Nagai T., Matsuyama T., Sakaguchi Y., Fujiwara S., Oh I., et al. Leukemia cells directly phagocytose blood cells in AML-associated hemophagocytic lymphohistiocytosis: a case report and review of the literature. Acta Haematol. 2015;133(1):98-100.

Publication Dates

• Publication in this collection
  27 May 2024
• Date of issue
  Jan-Mar 2024

History

• Received
  14 Aug 2023
• Accepted
  24 Aug 2023
• Published
  14 Sept 2023