Case Report

Central Nervous System Double Relapse of Acute Promyelocytic Leukemia and Acute Myelomonocytic Leukemia

Table 2

Key CBC and CSF studies during patient course.

CSF WBC (cm3)CSF RBC (cm3)CSF protein (mg/dl)Flow cytometry analysisFISH analysisWBC (×103/cm3)Hgb (gr/dl)Platelets (×103/cm3)

First APL/AMML double relapse1,0004 (normal range: 0–5)0 (normal range: 0-1)217 (normal range: 18–53)Flow cytometric analysis revealed a dysplastic population of myeloblasts comprising 19% of the total cells that are CD34+, CD117+, CD13+, CD33+, CD15−, CD64−, and CD14−30% of the cells had the t (15;17)(q22;q21) translocation. Only 50 interphase cells were evaluated7.9 (normal range: 4–11)14.2 (normal range: 11.3–15.2)146 (normal range: 150–440)
Second APL/AMML double relapse483 (normal range: 0–5)0 (normal range: 0-1)91 (normal range: 18–53)Wright-stained cytospin revealed numerous blasts. Many had abundant cytoplasm, and rare blasts contain cytoplasmic granules. No definite abnormal promyelocytes noted. Flow cytometric analysis revealed an aberrant population of myeloblasts comprising 72% of the total cells that are CD34+, CD117+, CD38−, CD13+, CD33+ (96.7), CD15−, CD64−, CD14−, CD7+, CD56 heterogenous, HLA-DRlo/+, and CD123+ (92.5%)60% of the cells had the t (15;17)(q22;q21) resulting in PML/RARA fusion7.42 (normal range: 4–11)13.3 (normal range: 11.3–15.2)227 (normal range: 150–440)