Erythropoietin-dependent transformation of myelodysplastic syndrome to acute monoblastic leukemia

Acute monoblastic leukemia (acute myeloid leukemia [AML], French-American-British type M5a) with leukemia cutis developed in a patient 6 weeks after the initiation of erythropoietin (EPO) therapy for refractory anemia with ringed sideroblasts. AML disappeared from both marrow and skin after the disc...

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Bibliographic Details
Published in:Blood 2001-12, Vol.98 (12), p.3492-3494
Main Authors: Bunworasate, Udomsak, Arnouk, Hilal, Minderman, Hans, O'Loughlin, Kieran L., Sait, Sheila N.J., Barcos, Maurice, Stewart, Carleton C., Baer, Maria R.
Format: Article
Language:English
Subjects:
Aged
Anemia, Sideroblastic - drug therapy
Anemia, Sideroblastic - pathology
Biological and medical sciences
Bone Marrow - pathology
CD13 Antigens - analysis
Drug toxicity and drugs side effects treatment
Erythropoietin - administration & dosage
Erythropoietin - adverse effects
Erythropoietin - therapeutic use
Flow Cytometry
Humans
Leukemia, Monocytic, Acute - chemically induced
Leukemia, Monocytic, Acute - metabolism
Leukemia, Monocytic, Acute - pathology
Leukocyte Common Antigens - analysis
Male
Medical sciences
Myelodysplastic Syndromes - pathology
Pharmacology. Drug treatments
Receptors, Erythropoietin - analysis
Skin - pathology
Toxicity: blood
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Summary:Acute monoblastic leukemia (acute myeloid leukemia [AML], French-American-British type M5a) with leukemia cutis developed in a patient 6 weeks after the initiation of erythropoietin (EPO) therapy for refractory anemia with ringed sideroblasts. AML disappeared from both marrow and skin after the discontinuation of EPO. Multiparameter flow cytometric analysis of bone marrow cells demonstrated coexpression of the EPO receptor with CD45 and CD13 on the surface of blasts. The incubation of marrow cells with EPO, compared to without, resulted in 1.3- and 1.6-fold increases, respectively, in tritiated thymidine incorporation and bromodeoxyuridine incorporation into CD13+ cells. Clinical and laboratory findings were consistent with the EPO-dependent transformation of myelodysplastic syndrome (MDS) to AML. It is concluded that leukemic transformation in patients with MDS treated with EPO may be EPO-dependent and that management should consist of the discontinuation of EPO followed by observation, if clinically feasible.
ISSN:0006-4971
1528-0020
DOI:10.1182/blood.V98.12.3492