Cutaneous Manifestations in CMML Might Indicate Disease Acceleration or Transformation to AML
RA Mathew, M Naghashpour, L Moscinski, J Messina, L Zhang. Moffitt Cancer Center, Tampa, FL; University of South Florida, Tampa, FL
Background: Chronic myelomonocytic leukemia (CMML) is a clonal disorder with myelodysplastic and myeloproliferative features. Hematologic findings of CMML could range from isolated monocytosis to panmyelosis with myelofibrosis. Leukemic involment of skin is not uncommon in acute monoblastic leukemia, acute myelomonocytic leukemia, or chronic myelogenous leukemia in blast crisis, but is rarely reported in CMML. To our knowledge, no case series studying cutaneous manifestations in CMML have been reported. Our study aims to explore the role of skin infiltrate by leukemic cells in disease progression and to correlate with clinical and therapeutic outcome.
Design: Bone marrow biopsies with diagnosis of CMML were retrieved from Moffitt Cancer Center during 1/2003-6/2009. The CBC data including absolute monocytes, immature monocytes and myeloblasts prior to, during and after skin biopsy were compared. Consequent bone marrow biopsies and tissue biopsies for each case were reviewed. Cases with peripheral blood flow cytometry or bone marrow diagnosis of acute myeloid leukemia after skin assessment were confirmed.
Results: Fifty-two cases (average age of 71 years, M:F= 3:1) of CMML are included in this study. Eleven of 52 patients have skin biopsies, 6 diagnosed as leukemia cutis, 1 as hematodermic neoplasm and 4 as non-leukemic lesions inluding a multicentric reticulohistiocytosis. Five of 6 patients with leukemia cutis (CBCs not available in one case), and 1 hematodermic neoplasm, demonstrated absolute monocytosis (ranging from 1160 to 8360/µl) without overt increase in myeloblasts or promonocytes at the time of skin biopsy. Half of patients with leukemia cutis(3/6) were found to have acute monocytic leukemia; 2 of them with other extramedullary involvement. The other half, were promptly treated as per current protocols, resulting in disease stabilization without leukemic transformation. In 2 patients, one with hematodermic neoplasm, and one with multicentric reticulohistiocytosis, transformation to AML occurred 4 months later and 15 days later, respectively.
Conclusions: Skin infiltrate by CMML is commonly associated with increased circulating monocytes without overt circulating blasts. Cutaneous manifestation may herald disease progression or transformation to acute leukemia (more cases need to be studied). Close clinical follow up and immediate therapy might prevent disease progression or transformation.
Wednesday, March 24, 2010 1:00 PM
Poster Session VI # 193, Wednesday Afternoon