Acute myelogenous leukaemia and myelomonocytic blast crisis following polycytemia vera in HIV positive patients: Report of cases and review of the literature

Background: Acute myelogenous leukaemia (AML) and myeloproliferative diseas es are rare in HIV-infected individuals and optimal treatment has not been defined. Patients and methods: We report on the cases of two HIV-infected men, one w ith AML and one with myeloid blast crisis after polycythaemia vera (PV). A comprehensive review of the available literature will be presented. Results: Patient 1, a 57-year-old bisexual man known to be HIV seropositive for more than four years (CDC-category A1), presented with a pulmonary inf iltrate. On admission WBC showed leukocytes 5.6 x 10(9)/l and the different ial revealed 80% blasts. A diagnosis of AML FAB M0 was made. Pneumonia reso lved under antibiotic reatment and the patient received induction chemother apy. However, he once more developed multiple pulmonary infiltrates and die d of respiratory failure despite broad spectrum antibiotic and antimycotic therapy. Autopsy revealed pulmonary aspergillosis. Patient 2 was a 63-year old HIV-positive hemophiliac (CDC A3) with a 10-year history of PV. On admi ssion his white cell count showed leukocytes 256.6 x 10(9)/l with 82% blast s. Cytochemistry revealed myelomonocytic differentiation. The patient died of tumor lysis syndrome with renal and cardio-pulmonary failure two days la ter. Conclusions: This is the first report of an HIV-infected individual with AM L M0. The literature describes the cases of 39 HIV+ patients with AML and o nly one further case with PV. The association of both, myeloproliferative d isease and AML with HIV infection is coincidental. However, the proportion of FAB type M4/5 appears to be higher than in the general population. Despi te a high risk of treatment associated mortality durable remissions can be achieved in a small proportion of HIV-infected patients with AML.