Acute Erythroid leukaemias

2002-07-01   Estella Matutes , Sally B Killick 

1.Department of Haematology, St George s Hospital Medical School, London, UK
2.Department of Haematology, St Georges Hospital Medical School, London, UK

Clinics and Pathology

Epidemiology

Acute erythroid leukaemia is an uncommon form of acute myeloid leukaemia (AML), accounting for approximately 3-4% of cases. Perhaps more than other subtypes of AML, it may represent the evolution or transformation of a myelodysplastic syndrome (MDS), and may be secondary to previous chemotherapy, immunosuppressive treatment or radiotherapy given for a wide range of malignant or non-malignant diseases. It is more commonly associated with exposure to alkylating agents or benzene than other subtypes of AML.

Clinics

Acute erythroid leukaemia presents with symptoms and signs of cytopenias. It is more common in adults than in children.

Cytology

Immunophenotype
  • Erythroleukaemia: The myeloid blasts express a variety of myeloid markers, similar to othe subtypes of AML ­ CD13, CD33, CD117 (ckit) and MPO. The erythroblasts lack myeloid antigens but are positive to glycophorin A.
  • Pure erythroid leukaemia: Erythroid blasts which have differentiated will be positive with glycophorin A but negative with MPO and myeloid markers. The more immature blasts are difficult to identify as erythroid because they are usually negative for glycophorin A. Immature erythroid progenitors may be detected using carbonic anhydrase 1 or CD36. Although CD36 is not specific for erythroid progenitors, negative markers for megakaryocytes and monocytes will aid the diagnosis.
  • Treatment

    The prognosis of acute erythroid leukaemia is reported as poor. It is, however, important to differentiate de novo from secondary or therapy related erythroid leukaemia, where the later have a worse prognosis. Remission induction for de novo disease is similar to other subtypes of AML, however the poor outcome has been linked to short remission duration. Patients with complex karyotypes or abnormalities of chromosomes 5 and/or 7 have a higher relapse rate than those with normal or simple karyotypes. Data from the Medical Research Council AML10 trial show reduced relapse rates in patients with both standard and poor risk AML after autologous bone marrow transplantation. It may, therefore, be reasonable to consider early stem cell transplantation in first complete remission in patients with acute erythroid leukaemia, particularly those with a poor risk karyotype.

    Bibliography

    Pubmed IDLast YearTitleAuthors
    38623591985Proposed revised criteria for the classification of acute myeloid leukemia. A report of the French-American-British Cooperative Group.Bennett JM et al
    31181051987Ultrastructural and cytochemical characterization of blasts from early erythroblastic leukemias.Breton-Gorius J et al
    95045141998Randomised comparison of addition of autologous bone-marrow transplantation to intensive chemotherapy for acute myeloid leukaemia in first remission: results of MRC AML 10 trial. UK Medical Research Council Adult and Children's Leukaemia Working Parties.Burnett AK et al
    23867681990Morphologic, immunologic and cytogenetic studies in erythroleukaemia: evidence for multilineage involvement and identification of two distinct cytogenetic-clinicopathological types.Cuneo A et al
    105121671999Acute erythroid leukemia (M6): outcome of bone marrow transplantation.Killick S et al
    14504121992Clinical, morphologic, and cytogenetic characteristics of 26 patients with acute erythroblastic leukemia.Olopade OI et al

    Summary

    Note

    Criteria for diagnosis of acute erythroid leukaemia

    Citation

    Estella Matutes ; Sally B Killick

    Acute Erythroid leukaemias

    Atlas Genet Cytogenet Oncol Haematol. 2002-07-01

    Online version: http://atlasgeneticsoncology.org/haematological/1215/acute-erythroid-leukaemias

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