title: Erythropoietin-dependent transformation of myelodysplastic syndrome to acute monoblastic leukemia.
abstract: 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.
authors.affiliation: Department of Medicine, Leukemia Section, Clinical Cytogenetics Laboratory, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
authors.forename: Udomsak
authors.initials: U
authors.lastname: Bunworasate
authors.forename: Hilal
authors.initials: H
authors.lastname: Arnouk
authors.forename: Hans
authors.initials: H
authors.lastname: Minderman
authors.forename: Kieran L.
authors.initials: KL
authors.lastname: O'Loughlin
authors.forename: Sheila N. J.
authors.initials: SNJ
authors.lastname: Sait
authors.forename: Maurice
authors.initials: M
authors.lastname: Barcos
authors.forename: Carleton C.
authors.initials: CC
authors.lastname: Stewart
authors.forename: Maria R.
authors.initials: MR
authors.lastname: Baer
mesh_terms: D000368:Aged; D000756:Anemia, Sideroblastic / Q000188:drug therapy / Q000473:pathology; D001853:Bone Marrow / Q000473:pathology; D018826:CD13 Antigens / Q000032:analysis; D004921:Erythropoietin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005434:Flow Cytometry; D006801:Humans; D007948:Leukemia, Monocytic, Acute / Q000139:chemically induced* / Q000378:metabolism / Q000473:pathology; D017493:Leukocyte Common Antigens / Q000032:analysis; D008297:Male; D009190:Myelodysplastic Syndromes / Q000473:pathology*; D017467:Receptors, Erythropoietin / Q000032:analysis; D012867:Skin / Q000473:pathology
chemical_list: D017467:Receptors, Erythropoietin; D004921:Erythropoietin; D017493:Leukocyte Common Antigens; D018826:CD13 Antigens