ACUTE MYELOGENOUS LEUKEMIA (FAB AML-M1) IN THE SETTING OF HIV-INFECTION AND G-CSF THERAPY - A CASE-REPORT AND REVIEW OF THE LITERATURE

Although hematologic dysplasia is common in HIV disease, evolution to AML is unusual. We report a case of AML in a patient with stage-C3 AID S who had been previously treated with granulocyte colony-stimulating factor (G-CSF). This 41-year-old black man presented with pancytopenia (Hg 8.6 g/dl, Hct 24.3%, platelets 16,000/mm(3), WBC 0.6 x 10(3)/mm(3 )) and hemoptysis. His peripheral smear manifested 19% blasts. His bon e marrow biopsy was hypocellular (20%) with greater than 90% blasts, w hich were positive for myeloperoxidase and Sudan black B. The blasts w ere negative for nonspecific esterase. Immunophenotypic analysis by fl ow cytometry showed the majority of cells to be of myeloid lineage, ex pressing CD13, and CD45 at low intensity. In addition, there was aberr ant expression of CD2 and no expression of CD14 or CD4. The diagnosis of AML-FAB-MZ was made. The patient re fused chemotherapy. Of the rare cases of AML in HIV patients previously reported in the literature, t he majority were of the monocytic or myelomonocytic subtype. This case is of special interest because of prior G-CSF therapy. In this settin g, the relationship between HIV, G-CSF, and subsequent AML is controve rsial.