A 36-year-old man presents to the emergency department complaining of severe low back pain. He reports a six-week history of progressive fatigue and worsening night sweats, and he notes gingival bleeding when he brushes his teeth. Physical examination is notable for borderline tachycardia and scattered ecchymoses on the extremities.
His laboratory results reveal the following: Count Value Reference Range White blood cells 42.1 × 10 9 /L 4 x 10 9 /L – 10 × 10 9 /L Hemoglobin 8.3 g/dL 14 – 18 g/dL Platelet count 18 × 10 9 /L 150 × 10 9 /L – 450 × 10 9 /L White blood cell differential is notable for 82 percent blasts. Bone marrow aspiration and biopsy is performed, revealing a hypercellular marrow involved with B cell precursor (BCP) acute lymphocytic leukemia (ALL), with malignant lymphocytes comprising 65 percent of total cellularity. Cytogenetics reveal a single abnormality — the…
