Dysplastic bone marrow changes during maintenance therapy for acute leukemia

Matteo Chinello, Samuele Naviglio, Alison Shardlow, Alessandro Severino, Alessandro Ventura, Anna Locasciulli

Research output: Contribution to journalArticlepeer-review


We describe the case of an 8-year-old girl with common precursor B-cell acute lymphoblastic leukemia who presented with severe pancytopenia during maintenance therapy with methotrexate and 6-mercaptopurine. The bone marrow smear showed moderate hypocellularity and trilinear dysplastic changes consistent with a diagnosis of drug toxicity, with no evidence of lymphoblasts. Flow cytometric immunophenotyping was negative for leukemic cells. Blood cell counts normalized after treatment with folinic acid. Maintenance therapy was gradually restarted and she remained well at follow-up visits. Myelotoxicity from methotrexate and 6-mercaptopurine may represent an unpredictable incident during an otherwise uneventful maintenance therapy, and may occur independently of other organ toxicities.

Original languageEnglish
Pages (from-to)156-157
Number of pages2
JournalJournal of Pediatric Hematology/Oncology
Issue number2
Publication statusPublished - Mar 6 2015


  • 6-mercaptopurine
  • acute lymphoblastic leukemia
  • megaloblastic anemia
  • methotrexate
  • pancytopenia

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Oncology
  • Hematology
  • Medicine(all)


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