PMC10240553_01
(a, b) Bone marrow smear during the initial examination, (c)-(j) Bone marrow biopsy, (k) Bone marrow smear on the complete remission. ((a) Smear (100x); hypoplastic bone marrow with lymphoblast. (b) Smear (1000x); small lymphoblast with agranular and distinct nucleoli. The chromatin is not condensed and the nucleocytoplasmic ratio is high. The cytoplasm is moderately basophilic. (c) Hematoxylin and eosin staining (40x); normocellular bone marrow with cellularity of 50%. Lymphoblast comprises 30%-50% of the nucleated cells. (d) CD3 (40x); negative. (e) CD10 (40x); positive. (f) CD20 (40x); negative. (g) CD79a (40x); positive. (h) CD34 (40x); weakly positive. (i) TdT (40x); positive. (j) Silver staining (40x); mild increase in reticular fibers. (k) Smear (200x); normocellular bone marrow without lymphoblast.)
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Bone marrow aspiration demonstrated slightly hypoplastic bone marrow (Figure 1(a)), with a nucleated cell count of 14,600/microL, including 37% small lymphoblasts (Figure 1(b)). Bone marrow biopsy (Figure 1(c)-(j)) showed normocellular bone marrow with 50% cellularity, with reduced number of granulocytic cells and few megakaryocytes and erythroblastic islands observed. The patient attained complete remission (CR) (Figure 1(k)) with a corresponding improvement in her overall health status.
Clinical course from the first visit.. PLT: platelet; Hb: hemoglobin; WBC: white blood cell; Neu: neutrophil; G-CSF: granulocyte colony-stimulating factor; BM: bone marrow; CR: complete remission.
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Following the confirmation of an HLA-matched sibling donor, chemotherapy was initiated 6 months after the initial visit (Figure 2).