Myeloproliferative syndrome with leukemia preceding polycythemia vera; a case report.

SSOCIATED PROLIFERATION of the various hematologic elements in the marrow, although recognized for some time,2 has recently been the subject of renewed interest.3’8 A close relationship between myelofibrosis and he leukoerythroblastic conditions was demonstrated by Vaughan and HarrisonT in 1939. They suggested that an unknown stimulus acting on the primitive mesenchymal reticulum cell may be responsible for the production of this closely related group of diseases which Dameshek has called “myeloproliferative disorders.”1 In this background the intimate association of polycythemia vera and myelogenous leukemia is readily understood. Between the relatively pure clinical pictures at each extreme there occur varying degrees of mixed or transitional forms which Martin and Bayrd have classified into different subtypes of “erythroleukemia.”8 It would appear that conversion of polycythemia vera into myelogenous leukemia or the simultaneous presence of the two is by far the most common course of events. l4huiO’2o The following case is of interest because a picture of chronic granulocytic leukemia preceded the appearance of polycythemia vera.