title: Acute erythroid neoplastic proliferations. A biological study based on 62 patients.
abstract: OBJECTIVE
  The terms acute erythroleukemia and AML-M6 are defined in the FAB classification as proliferations of dysplastic erythroid elements mixed with blasts of myeloid origin, but pure erythroid leukemias are not included. The recent WHO classification has a category of acute myeloid leukemia not otherwise categorized, which includes acute erythroid leukemia (M6) of two subtypes: M6a-erythroleukemia (erythroid/myeloid) and M6b-pure erythroid leukemia. The aims of this co-operative study were to discover the incidences of these different subtypes, and pay special attention to the morphology of these entities.
  
  
  METHODS
  We reviewed a series of 62 patients with erythroid neoplastic proliferations. Previous medical history, age, sex, peripheral blood and bone marrow cell counts, cytochemical stains, immunophenotype, and cytogenetics were evaluated at presentation. We analyzed the incidence of erythrocyte, leukocyte and platelet abnormalities in the peripheral blood. In bone marrow we analyzed dysplastic features of erythroblasts, granulocytic elements and the megakaryocytic lineage.
  
  
  RESULTS
  Fifty-three patients met the criteria of M6a subtype of the WHO classification, and 2 were classified as having pure erythremia (M6b); 7 cases could not be classified according to the WHO criteria. Fifty-five patients presented with de novo acute leukemia, and seven patients had secondary acute leukemia. The most frequent dysplastic features in blood smears were: schistocytes, tear-drop and pincered cells in erythrocytes; hypogranulation and hyposegmentation in leukocytes; gigantism and hypogranulation in platelets. In bone marrow, megaloblastic changes, multinuclearity, karyorrhexis and basophilic stippling in erythroblasts; hypogranulation and gigantism in granulocytic series, and micromegakaryocytes and unconnected nuclei in megakarocytes were the most dysplastic features. A positive PAS reaction and increase of bone marrow iron with ring sideroblasts were common features. Trilineage dysplasia was present in 54% of cases. Dysplastic features in granulocytic elements were absent in 26% of patients and minimal erythroblastic dysplasia was observed in seven patients. A complex karyotype was seen in 27% of patients; chromosomes 5 and 7 were the most frequently involved.
  
  
  CONCLUSIONS
  De novo acute erythroid leukemia was more frequent than secondary cases in our series. The most frequent type of acute erythroid proliferation was the WHO M6a subtype and the least the pure erythroid leukemia. We found a group of seven patients (11%) who could not be classified according to the WHO criteria. Morphologic findings of erythrocytes in peripheral blood, such as schistocytes, tear-drop and pincered cells, were outstanding features. Morphologic aspects remain one of the most important tools for diagnosing these entities.
authors.affiliation: Ciudad Sanitaria y Universitaria de Bellvitge, L'Hospitalet del Llobregat 08907, Barcelona, Spain. alicia@domingo.com
authors.forename: Alicia
authors.initials: A
authors.lastname: Domingo-Claros
authors.forename: Itziar
authors.initials: I
authors.lastname: Larriba
authors.forename: Maruja
authors.initials: M
authors.lastname: Rozman
authors.forename: Dolors
authors.initials: D
authors.lastname: Irriguible
authors.forename: Teresa
authors.initials: T
authors.lastname: Vallespí
authors.forename: Anna
authors.initials: A
authors.lastname: Aventin
authors.forename: Ramon
authors.initials: R
authors.lastname: Ayats
authors.forename: Fuensanta
authors.initials: F
authors.lastname: Millá
authors.forename: Francesc
authors.initials: F
authors.lastname: Solé
authors.forename: Lourdes
authors.initials: L
authors.lastname: Florensa
authors.forename: Miquel
authors.initials: M
authors.lastname: Gallart
authors.forename: Esperanza
authors.initials: E
authors.lastname: Tuset
authors.forename: Carmen
authors.initials: C
authors.lastname: Lopez
authors.forename: Soledad
authors.initials: S
authors.lastname: Woessner
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001853:Bone Marrow / Q000473:pathology; D019070:Cell Lineage; D002869:Chromosome Aberrations; D018450:Disease Progression; D004913:Erythrocytes, Abnormal / Q000473:pathology; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D007621:Karyotyping; D004915:Leukemia, Erythroblastic, Acute / Q000097:blood / Q000145:classification / Q000453:epidemiology / Q000235:genetics / Q000473:pathology*; D007951:Leukemia, Myeloid / Q000097:blood / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000453:epidemiology; D010503:Periodic Acid-Schiff Reaction; D011289:Preleukemia / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis