Chronic Myelogenous Leukemia With Myelofibrosis: Four Years After Auto-immune Hemolytic Anemia

ALTHOUGH in typical cases myelofibrosis with myeloid metaplasia is distinguishable from chronic myelogenous leukemia, there exist a number of cases in which the abnormalities are sufficiently similar to make differential diagnosis difficult. The extreme case of myelofibrosis shows complete replacement of hematopoietic elements by connective tissue, either fibrous or osseous or both, and the classical chronic myelogenous leukemic marrow is hypercellular with a striking granulocytic preponderance, increased megakaryocytes, and normal nucleated or occasionally "megaloid" erythrocytes. However, the marrow pictures in the two conditions may be almost identical since myelofibrosis may be preceded or accompanied by hyperplasia of the marrow, 1 and the marrow of undoubted cases of chronic myelogenous leukemia may show fibrosis in the later stages of the disease. 2 These cases have raised the question of whether myelofibrosis with myeloid metaplasia and chronic myelogenous leukemia are different manifestations of the same fundamental disturbance. 3 Newer techniques such as chromosome analysis and