The recent report by Tallman et al1 on the Eastern Cooperative Oncology Group's experience with acute megakaryocytic leukemia contains an apparent inconsistency. In the methods section it is stated that the “bone marrow aspirate or biopsy leukemic blast cell population must have represented 30% or more of the myeloid marrow.”1(p2406) This widely accepted French-American-British (FAB) criterion for the diagnosis of acute granulocytic leukemia, however, does not appear to have been met by several of the patients listed in Table 1. Patients 2, 12, and 14 are reported as having only 10%, 5%, and 15% marrow blasts, respectively, and in an additional 3 patients (10, 11, and 13) marrow blasts are reported as “NA.” How was the diagnosis established in these patients?
Diagnosis of acute megakaryocytic leukemia
We appreciate the comment from Dr Strauchen, since a strict interpretation of the percent blasts being less than 30% for the 6 patients he mentions is correct. But in all of these cases, there was a significant percentage of circulating blasts, ranging from 7% to 63%, and there was considerable marrow fibrosis that prevented doing a precise marrow blast count. In case 12, the high platelet count, severe marrow fibrosis, and dysplastic megakaryocytes permitted the diagnosis to be established.1-1 An additional reference that provides more insight into the diagnosis of the acute myeloid leukemia is Cheson et al.1-2
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