In a 71-year-old man, acute myelomonocytic leukemia developed six years after a diagnosis of paroxysmal nocturnal hemoglobinuria (PNH) had been established. The classic features of PNH disappeared with the onset of the leukemia. Chemotherapy resulted in complete leukemic remission, during which time intravascular hemolysis and a positive acidified serum (Ham's) test recurred; both findings again disappeared when the leukemia recurred. To our knowledge, this is the eighth reported case of PNH terminating in acute leukemia but is the first in which reappearance of PNH has been documented with leukemic remission. The alternating pattern of the two disorders suggests that the PNH clone survives in the bone marrow when leukemia supervenes.
(Arch Intern Med 1981;141:525-527)
Hirsch VJ, Neubach PA, Parker DM, Reese MH, Stone MJ. Paroxysmal Nocturnal HemoglobinuriaTermination in Acute Myelomonocytic Leukemia and Reappearance After Leukemic Remission. Arch Intern Med. 1981;141(4):525–527. doi:10.1001/archinte.1981.00340040121030