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Myeloid leukemoid reaction after initial azacitidine therapy for chronic myelomonocytic leukemia

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Abstract

The development of myeloid leukocytosis in leukemia patients during antileukemic treatment requires a differential diagnosis between myeloid leukemoid reaction and leukemia progression. We herein report the case of an 80-year-old Japanese man with chronic myelomonocytic leukemia (CMML) who developed marked myeloid leukocytosis (36.3 × 109/L) with 32.5% monocytes and 48% neutrophils about 4 weeks after the initial 5-azacitidine (AZA) treatment. The leukocytosis was unlikely to be attributed to infection and adverse drug reaction. As it resolved in a few days without any interventions, the transient myeloid leukocytosis was confirmed to be a myeloid leukemoid reaction. After four cycles of AZA treatment, leukemic blasts in the bone marrow decreased and the patient became transfusion-independent. Interestingly, levels of serum G-CSF showed a similar trend to the myeloid leukocytosis, while those of serum GM-CSF and IL-17 were undetectable throughout the clinical course, suggesting that a differentiation response to AZA treatment might lead to the myeloid leukemoid reaction. Our case implies that a marked but transient myeloid leukemoid reaction mimicking CMML progression can develop during AZA treatment, which requires careful clinical monitoring and differential diagnosis.

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Acknowledgements

We are grateful to Dr. Hironori Harada and Dr. Yuka Harada (Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital) for next-generation sequencing, and to Dr. Takahiko Hara (Tokyo Metropolitan Institute of Medical Science) for laboratory measurements of IL-17.

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Authors and Affiliations

  1. Department of Hematology, Tama-Hokubu Medical Center, Tokyo Metropolitan Health and Medical Treatment, Corporation 1-7-1 Aobachou, Higashimurayama-shi, Tokyo, 189-8511, Japan

    Takeshi Hagino, Reina Saga, Hiroko Hidai, Yoshiro Murai, Hideki Akiyama & Sayuri Motomura

  2. Division of Transfusion Medicine and Cell Therapy, The Jikei University Hospital, Tokyo, Japan

    Tomohiko Sato

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  1. Takeshi Hagino
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  2. Tomohiko Sato
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Correspondence to Takeshi Hagino.

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Hagino, T., Sato, T., Saga, R. et al. Myeloid leukemoid reaction after initial azacitidine therapy for chronic myelomonocytic leukemia. Int J Hematol 116, 961–965 (2022). https://doi.org/10.1007/s12185-022-03422-9

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  • DOI: https://doi.org/10.1007/s12185-022-03422-9

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