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Table 1 Timeline of case report

From: Neutropenia caused by hairy cell leukemia in a patient with myelofibrosis secondary to polycythemia vera: a case report

Date

Summaries of visits and treatments

Diagnostic testing

1995

Polycythemia vera

Phlebotomy

Hb 22.2 g/dl, Hct 0.64, WBC 10.1 × 109/L, TPK 162 × 109/L

2008

Stable Hb

Phlebotomy stopped

Hb 13.3 g/dl

2009

Mouth ulcers, prednisolone without effect

Mouth biopsy showed “acute and chronic inflammation.”

March 2012

Leukopenia, thrombocytopenia

Bone marrow biopsy showed fibrosis grade 1, “spent phase” polycythemia vera; in retrospect, also hairy cell leukemia.

Hb 13.2 g/dl, WBC 2.7 × 109/L, neutrophils 1.4 × 109/L, monocytes 0.1 × 109/L, lymphocytes 1.20.1 × 109/L, TPK 102 × 109/L

April–May 2013

Worsening of leukopenia, thrombocytopenia

Temporary effect of filgrastim on neutrophils and partly on mouth ulcers

Bone marrow biopsy: increased cellularity and fibrosis grade 2–3; in retrospect, also hairy cell leukemia

Hb 11.6 g/dl, WBC 2.4 × 109/L, neutrophils 1.1 × 109/L, monocytes 0.1 × 109/L, lymphocytes 1.20.1 × 109/L, TPK 98 × 109/L

April 2014

Myelofibrosis

Pancytopenia

Bone marrow biopsy with fibrosis grade 3, osteosclerosis; in retrospect, also AML and hairy cell leukemia

Complex cytogenetics

Hb 9.7 g/dl, WBC 2.3 × 109/L, neutrophils 0.8 × 109/L, monocytes < 0.1 × 109/L, lymphocytes 1.40.1 × 109/L, TPK 41 × 109/L

May–August 2014

Repeated hospitalizations with febrile neutropenia

Thalidomide and prednisolone without effect

 

October 2014

Cladribine, temporary effect

Bone marrow biopsy with suggested AML and hairy cell leukemia

March 2015

Death

 
  1. Abbreviations: Hb Hemoglobin, Hct Hematocrit, TPK Platelet count, AML Acute myeloid leukemia, WBC White blood cells