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Therapy-related acute myeloid leukemia and myelodysplastic syndrome: a
clinical and morphologic study of 65 cases
SD Michels, RW McKenna, DC Arthur and RD Brunning
This study consists of 65 patients (pts) who developed a myelodysplastic
syndrome (MDS) (39 pts) or acute myeloid leukemia (AML) (26 pts) following
chemotherapy and/or radiotherapy; the interval from the onset of therapy to
bone marrow abnormality ranged from 11 to 192 months (median, 58).
Thirty-three patients had been previously treated for lymphoproliferative
diseases, 29 for carcinoma, and three for a nonneoplastic disorder.
Approximately 30% of the cases presenting in the MDS phase evolved to AML
in one to 12 months (median, 3.5). The AML in 49% of the cases was not
readily classified according to French- American-British (FAB) criteria;
the primary difficulty in classification related to the involvement of
multiple cell lines. Among the cases that could be classified, all FAB
types were represented except for M1; M2 was the most frequent type. Clonal
chromosome abnormalities were found in marrow specimens from 22 of 24 (92%)
patients studied with G banding; 11 had abnormalities of chromosomes 5
and/or 7. The median survival for all patients was four months with no
significant difference between those treated and not treated with
antileukemic therapy. The median survival was three months for the patients
presenting with AML, six months for the patients with AML following an MDS,
and four months for the patients with an MDS that did not evolve to AML.
The findings in the present study suggest that there are three stages of
therapy-related panmyelosis: (1) pancytopenia with associated
myelodysplastic changes, (2) a frank MDS, and (3) overt AML. Many patients
will present in the stage of overt AML that differs from de novo AML
primarily by the high incidence of trilineage involvement, difficulty in
classification, frequent cytogenetic abnormalities, and poor response to
antileukemic therapy. The myelodysplastic phase, with or without evolution
to acute leukemia, is a highly lethal disease with a median survival
comparable to that of the patients who present with AML.
Volume 65,
Issue 6,
pp. 1364-1372,
06/01/1985
Copyright © 1985 by The American Society of Hematology
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