Pre-ALL in an Adolescent Girl

Abstract

A 15-year-old girl who exhibited the clinical picture of pre-ALL at the onset of disease was reported. She had persistent low-grade fever and mild liver dysfunction on admission. A laboratory examination revealed leukopenia and thrombocytopenia, except for the appearance of blasts in a smear of peripheral blood. But the percentage of blasts in the marrow gradually increased following repeated examinations for 3 weeks, resulting in a diagnosis of ALL. This clinical picture is compatible with pre-ALL, which is manifested as leukopenia with scanty blasts in the marrow. However, two points are different from reported cases. One was older at the time of presentation, and the other was shorter in duration between the onset of disease and the overt leukemia than those of reported cases. G-CSF, which was used for the leukopenia at the initial presentation, seemed to have some role in the development of overt leukemia, considering that ALL was apparent shortly after its use. But blasts were not increased during remission induction and maintenance chemotherapy thereafter, in spite of routine G-CSF administration.