title: Bone marrow necrosis in adult acute leukemia and non-Hodgkin's lymphoma.
abstract: Bone marrow necrosis is a rare finding in adult patients diagnosed with acute leukemia or non-Hodgkin's lymphoma. Previous reports have suggested that it is associated with a poor prognosis. It remains unclear however, whether improvements in patient care during the last decade have altered patient outcome. In a retrospective review of 581 bone marrow biopsies performed ante mortum on adult patients with acute leukemia or non-Hodgkin's lymphoma, we identified 10 cases of bone marrow necrosis (5 acute myeloid leukemia, 5 non-Hodgkin's lymphoma). Severe bone pain, elevated serum lactate dehydrogenase levels and leukoerythroblastic peripheral blood smears were common presenting features. Despite treating 8 of the 10 patients with curative intent, only 2 patients remain alive and disease-free. This study confirms that bone marrow necrosis in adults with acute leukemia and non-Hodgkin's lymphoma is a rare ante mortum finding and confers a poor prognosis. Whether these patients would benefit from more intensive therapy such as hematopoietic stem cell transplantation remains to be clarified.
authors.affiliation: Division of Hematology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. dforrest@is.dal.ca
authors.forename: D L
authors.initials: DL
authors.lastname: Forrest
authors.forename: B J
authors.initials: BJ
authors.lastname: Mack
authors.forename: T J
authors.initials: TJ
authors.lastname: Nevill
authors.forename: S H
authors.initials: SH
authors.lastname: Couban
authors.forename: E
authors.initials: E
authors.lastname: Zayed
authors.forename: A
authors.initials: A
authors.lastname: Foyle
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001853:Bone Marrow / Q000473:pathology*; D005260:Female; D006801:Humans; D007938:Leukemia / Q000473:pathology*; D008228:Lymphoma, Non-Hodgkin / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009336:Necrosis