2019, Number 4
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Bol Med Hosp Infant Mex 2019; 76 (4)
Agressive NK-cell leukemia in a pediatric patient
Rey-Helo E, Pérez-Velásquez RD, Cortés-Alva D
Language: Spanish
References: 13
Page: 188-192
PDF size: 217.27 Kb.
ABSTRACT
Background: Natural killer (NK) cell neoplasms are rare and represent ‹5% of all lymphoid neoplasms. They involve different
clinical entities, of which one is NK cell leukemia, a highly aggressive hematologic neoplasm with poor prognosis that presents
in young men and is more frequently seen in Asian descent. Epstein-Barr virus (EBV) seems to be related to the pathogenesis.
Case report: A male patient of 1 year and 7 months of age, who began his condition with anemic, febrile, infiltrative
syndrome and hyperleukocytosis is described. Bone marrow aspirate showed L2 morphology blasts (96%), CD56 (80.87%)
and terminal deoxynucleotidyl transferase (84.11%) immunophenotype. Bone marrow biopsy showed membranous CD2+, cytoplasmic CD3+ and membranous CD56+; serology positive to EBV. The patient received two different chemotherapy
schemes based on methotrexate, ifosfamide, etoposide, dexamethasone and L-asparaginase, which resulted in partial remission.
Currently, the patient lives with the disease.
Conclusions: NK cells leukemia is rare in young adults, but even more in
pediatric patients, for which it is very difficult to treat because only a few cases have been reported in the literature, the
survival varies from weeks to months and the chances of treatment are limited. Recently, the usefulness of allogeneic bone
marrow transplantation or umbilical cord cells has been demonstrated, achieving a 2-year survival. The therapeutic possibilities
in these patients are under study. In the near future, we hope to achieve the complete remission of the disease and a
5-year survival.
REFERENCES
Ishida F, Kwong YL. Diagnosis and management of natural killer-cell malignancies. Expert Rev Hematol. 2010;3:593-602.
Fernandez LA, Pope B, Lee C, Zayed E. Aggressive natural killer cell leukemia in an adult with establishment of an NK cell line. Blood. 1986;67:925-30.
Greer JP, Mosse CA. Natural killer-cell neoplasms. Curr Hematol Malig Rep. 2009;4:245-52.
Wong KF, Zhang YM, Chan JK. Cytogenetic abnormalities in natural killer cell lymphoma/leukaemia—is there a consistent pattern? Leuk Lymphoma. 1999;34:241-50.
Yamamoto T, Iwasaki T, Watanabe N, Oshimi K, Naito M, Tsuruo T, et al. Expression of multidrug resistance P-glycoprotein on peripheral blood mononuclear cells of patients with granular lymphocyte-proliferative disorders. Blood. 1993;81:1342-6.
Sandlund JT, Pui C-H, Mahmoud H, Zhou Y, Lowe E, Kaste S, et al. Efficacy of high-dose methotrexate, ifosfamide, etoposide and dexamethasone salvage therapy for recurrent or refractory childhood malignant lymphoma. Ann Oncol. 2011;22:468-71.
Steinway SN, Leblanc F, Loughran TP Jr. The pathogenesis and treatment of large granular lymphocyte leukemia. Blood Rev. 2014;28:87-94.
Yamaguchi M, Kwong Y-L, Seog Kim W, MaedaY, Hashimoto C, Suh C, et al. Phase II study of SMILE chemotherapy for newly diagnosed stage IV, relapsed, or refractory extranodal natural killer (NK)/T-cell lymphoma, nasal type: The NK-cell tumor Study Group Study. J Clin Oncol. 2011; 29:4410-6.
Lepe-Zúñiga JL, Jerónimo-López FJ, Hernández-Orantes JG. Características citopatológicas de la leucemia aguda en el Hospital de Especialidades Pediátricas de Chiapas, México. Bol Med Hosp Infant Mex. 2017; 74:122-33.
Dearden C. Large granular lymphocytic leukaemia pathogenesis and management. Br J Haematol. 2011;152:273-83.
Suzuki R, Suzumiya J, Nakamura S, Aoki S, Notoya A, Ozaki S, et al. Aggressive natural killer-cell leukemia revisited: large granular lymphocyte leukemia of cytotoxic NK cells. Leukemia. 2004;18:763-70.
Lima M. Aggressive mature natural killer cell neoplasms: from epidemiology to diagnosis. Orphanet J Rare Dis. 2013;8:95.
Ebihara Y, Manabe A, Tanaka R, Yoshimasu T, Ishikawa K, Iseki T, et al. Successful treatment of natural killer (NK) cell leukemia following a long-standing chronic active Epstein–Barr virus (CAEBV) infection with allogeneic bone marrow transplantation. Bone Marrow Transplant. 2003;31:1169-71.