{"title":"Malignant clonal evolution from high proportion of monocytes in patients with aplastic anemia: a case report.","authors":"Qiuhao Fu, Lingling Liu, Yingmei Li","doi":"10.21037/sci-2022-049","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Aplastic anemia (AA) is a heterogeneous group of hematopoietic failure diseases, characterized mainly by immune hyperfunction, impaired immune tolerance, the hematopoietic microenvironment, and hematopoietic stem or progenitor cell deficiency. Oligoclonal hematopoiesis and clonal evolution make the disease more complicated, and extremely challenging to diagnose. After immunosuppressive therapy (IST) and granulocyte colony-stimulating factor (G-CSF) treatment, AA patients have a risk of developing acute leukemia.</p><p><strong>Case description: </strong>Here we report a patient with a relatively high proportion of monocytes, and all other tests were consistent with severe aplastic anemia (SAA). Monocytes increased rapidly after G-CSF treatment and were eventually diagnosed as hypo-hyperplastic acute monocytic leukemia 7 months later. A high proportion of monocytes may predict malignant clonal evolution in patients with AA. In combination with the literature, we recommend paying close attention to monocytes' elevation in patients with AA for clonal evolution and accurately selecting treatment options.</p><p><strong>Conclusions: </strong>The proportion of monocytes in the blood and bone marrow of AA patients should be closely monitored. Hematopoietic stem cell transplantation (HSCT) should be performed as early as possible once monocytes continue to increase or are associated with phenotypic abnormalities or genetic mutations. The unique value of this study is that although there were case reports about AA-derived acute leukemia, we suggested that an early high proportion of monocytes may predict malignant clonal evolution in patients with AA.</p>","PeriodicalId":21938,"journal":{"name":"Stem cell investigation","volume":"10 ","pages":"11"},"PeriodicalIF":0.0000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f9/13/sci-10-2022-049.PMC10200712.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Stem cell investigation","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.21037/sci-2022-049","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"Biochemistry, Genetics and Molecular Biology","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Aplastic anemia (AA) is a heterogeneous group of hematopoietic failure diseases, characterized mainly by immune hyperfunction, impaired immune tolerance, the hematopoietic microenvironment, and hematopoietic stem or progenitor cell deficiency. Oligoclonal hematopoiesis and clonal evolution make the disease more complicated, and extremely challenging to diagnose. After immunosuppressive therapy (IST) and granulocyte colony-stimulating factor (G-CSF) treatment, AA patients have a risk of developing acute leukemia.
Case description: Here we report a patient with a relatively high proportion of monocytes, and all other tests were consistent with severe aplastic anemia (SAA). Monocytes increased rapidly after G-CSF treatment and were eventually diagnosed as hypo-hyperplastic acute monocytic leukemia 7 months later. A high proportion of monocytes may predict malignant clonal evolution in patients with AA. In combination with the literature, we recommend paying close attention to monocytes' elevation in patients with AA for clonal evolution and accurately selecting treatment options.
Conclusions: The proportion of monocytes in the blood and bone marrow of AA patients should be closely monitored. Hematopoietic stem cell transplantation (HSCT) should be performed as early as possible once monocytes continue to increase or are associated with phenotypic abnormalities or genetic mutations. The unique value of this study is that although there were case reports about AA-derived acute leukemia, we suggested that an early high proportion of monocytes may predict malignant clonal evolution in patients with AA.
期刊介绍:
The Stem Cell Investigation (SCI; Stem Cell Investig; Online ISSN: 2313-0792) is a free access, peer-reviewed online journal covering basic, translational, and clinical research on all aspects of stem cells. It publishes original research articles and reviews on embryonic stem cells, induced pluripotent stem cells, adult tissue-specific stem/progenitor cells, cancer stem like cells, stem cell niche, stem cell technology, stem cell based drug discovery, and regenerative medicine. Stem Cell Investigation is indexed in PubMed/PMC since April, 2016.