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Blood, 1 December 2001, Vol. 98, No. 12, pp. 3492-3494

BRIEF REPORT

Erythropoietin-dependent transformation of myelodysplastic syndrome to acute monoblastic leukemia

Udomsak Bunworasate, Hilal Arnouk, Hans Minderman, Kieran L. O'Loughlin, Sheila N. J. Sait, Maurice Barcos, Carleton C. Stewart, and Maria R. Baer

From the Departments of Medicine and Pathology, Leukemia Section, Clinical Cytogenetics Laboratory and Laboratory of Flow Cytometry, Roswell Park Cancer Institute, Buffalo, NY

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.

© 2001 by The American Society of Hematology.
 

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