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Re: !!please !AML, M6(erythremic myelosis or Diguglielmo disease-remission ciretria

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±èÁ¾¿Ï wrote:

> <AML, M6(erythremic myelosis or Diguglielmo disease-remission ciretria>

> Dear Sir
>   I am a clinical pathologist working for Dankook University Hospital.
>   I would like to have a good opinion for a bone marrow study case.
>   The patient is a 27 year old woman whose bone marrow study shows
>  hypercellular marrow and most of cells composed of erythroid precursor
>  cells, predominently pronormoblasts. Followings are detail.
>   M:E ratio is about 0.043:1(1:22.7).
>   Erythroblasts are increased and counted upto 86.2 % of ANC.
>   Pronormoblasts predominates(about 38.6 % of ANC).
>   Granulopoisis is markedly decreased(5.6%).
>   Nonerythroid blasts are not increased, and they are
>  counted about 0.8% of NEC.
>   Megakarycytes are hardly observed.
>   Dyserythropoietic changes are also observed.
>   In the biopsy section, cellularity is about 95% and marrow space is
>  almostly packed with erythroblasts.
>  So, We diagnosed it as AML, M6(Erythremic myelosis type).
>   After induction chemotherapy, second BM study shows 6% of
>  pronormoblast, 1.5:1 of ME ratio, 20 % of cellularity, and focal
>   erythoid precusors clusters in biopsy specimen.
>  Generally, the focus in the remission criteria of AML is myeloblast
> count.
>  But this bone marrow is richly occupied by erythriod series not
>  associated with a myeloblast component.
>  What I want to know is the remission criteria of erythremic myelosis.
>  Please let me know if you have a good opinion on my case.

>  Sincerely.

>  from JongWan Kim, MD. (wan1…
>  to,,

A FAB classification purist would probably classify your case as a
myelodysplastic syndrome because of the paucity of type 1 and type 2
myeloblasts although others would as you did classify this case as acute
myeloid leukemia M6B. It is probably a matter of semantics because the
natural history of these cases are similar with a generally poor
response to therapy and short survival and frequent association with
complex karyotypic abnormalities. As far as I know there are no criteria
published specifically for this rare variant of acute myeloid leukemia
but I would consider a patient with this subtype in remission if the
marrow cellularity was greater than 20% with no evidence of dysplastic
pronormoblasts with vacuolated and PAS positive cytoplasm and less than
5% type 1 and type 2 myeloblasts and no detectable Auer rods. In
addition the patient should have an absolute blood neutrophil count of
greater than or equal to 1500/mm3 and a platelet count greater than
100,000/mm3. I would also like to see a normal marrow cytogenetic or
FISH study if the original marrow was abnormal, although the latter is
not considered an absolute criterion for clinical or hematologic

Richard Miller M.D.
"alles ist nur ein Uebergang"

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One Response to “Re: !!please !AML, M6(erythremic myelosis or Diguglielmo disease-remission ciretria”

  1. admin says:

    >Are there pathologists who specialize specifically in placentas?

    Look for the pathologists who have published in this area.  Benirschke
    (spelling?)  and  Naeye (Hershey Med Ctr, PA) come to mind.

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    >Are there particular experts in this field and how does one find one of
    >these specialists?

    >Are there particular journals where these experts publish?

    >Thanks in advance…


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