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RETROSPECTIVE EVALUATION OF M3 VARIANT IN CHILDREN

M3 variant isa subtype of acute promyelocytic leukaemia (APL) (Bennett et al, 1980; Berger et al, 1979; Canth Rajnoldi et al, 1981; Golomb et al, 1980; Testa et al, 1978) characterized by a typical morphological picture, evidence of disseminated intravascular coagulation (DIC), frequently hyperleucocytosis and a poor prognosis. A translocation t(l5;17) is present (Berger et al, 1979; Golomb et al, 1980; Testa et al, 1978). A 10 years retrospective review of bone marrow and peripheral blood smears from 75 patients with acute non-lymphoblastic leukaemia (ANLL) presenting in childhood was made, the slides being studied by three observers without preknowledge of patient identity. Three new cases with the typical morphological picture of the M3 variant (monocytoid bilobed agranular or hypogranular cells) were identified. With our previous case (Canth Rajnoldi et al, 1981) this gives an incidence of 4/75 (5.3%) in our ANLL paediatric patients. Analysis of these four patients shows an impressive similarity in their clinical and haematological features and in the rapidly fatal outcome (1-6 d). In all these cases DIC and hyperleucocytosis were present (WBC above 50 OOO/mm’) and death was due to cerebral haemorrhage. Three of four patients died soon after starting chemotherapy, probably in relation to the lysis of blast cells. The original diagnosis was acute myeloblastic leukaemia in three cases and myelomonocytic leukaemia in one case. The only paediatric patient described hitherto in the literature (Berger et al, 1979) showed an identical outcome and died 5 d after hospital admission. ’