We have experienced two cases of VAHS occurring after chemotherapy for AML, and
their clinical course and BM findings are so characterisitic that we report these cases
and review some articles. Nine-year-old boy was diagnosed as myelodysplastic
syndrome, R/O AML and after 2nd Denver induction chemotherapy he suffered from
pancytopenia and high fever. Bone marrow study showed a prominent increase of
hemophagocytic histiocytes(45% of all nucleated cells) which had RBC, WBC, platelets
and cellular debris in their cytoplasm. The other case was 6.5-year- old girl who had
neurofibromatosis. She was diagnosed as AML, M6 initially, and after 3 cycles of
induction chemotherapy and 2 cycles of Denver maintenance chemotherapy, that was
transformed to AML, M4. After 3rd cycle of Denver maintenance chemotherapy she was
diagnosed as "known AML in persistence with hemophagocytic syndrome" finally. Both
were failed to chemotherapy. The first one was died of DIC, cellulitis and liver failure
on the 55th admission day, and the second case was discharged hopelessly due to high
fever, pancytopenia and sepsis on the 26th admission day.
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