Presenting symptoms in patients with acute leukemia are highly variable (Table 3.1) but most are caused by hematopoietic insufficiency. Typically, the onset of symptoms is acute, within weeks to a few months before diagnosis, except in those patients who develop leukemia secondary to a pre-existing hematologic disease such as myelodysplastic syndromes (MDS) or myeloproliferative neoplasms. Infiltration of extramedullary organs by leukemic blasts is found in 2.5–9% of acute myeloid leukemia (AML) patients. Lymphadenopathy and/or hepatosplenomegaly are present in up to 50% of patients with acute lymphoblastic leukemia (ALL), and patients with T-lineage ALL frequently present with a mediastinal mass. Involvement of the central nervous system (CNS), most commonly manifesting in the cerebrospinal fluid (CSF), is detectable in <5% of adults with AML and in ~5% of adults with ALL at the time of initial diagnosis [1]. Fever is one of the most common presenting symptoms in patients with acute leukemias. Fever should always be interpreted as a sign of infection, and should prompt a careful search for infectious foci. Rapid initiation of empirical, broad-spectrum antibiotic coverage is usually indicated in febrile patients. Fever as a direct manifestation of leukemia without coexisting infection is rare.
15-11-2016 | Acute leukemia | Article