Hypoplastic myelodysplastic syndrome transformed in acute myeloid leukemia after androgens and cyclosporin. A treatment.
The apparent contradiction between clonal expansion and marrow failure encountered in myelodysplastic syndromes (MDS) is more evident in hypocellular forms at presentation. Hypoplastic MDS (hMDS) appears to be a distinct clinicopathologic entity, accounting for about 15% from all MDS. The pathogeny is supposed to result from immunosupressive mechanisms and some observations on successful treatment with Cyclosporine A (CsA) are reported. The case of a young female patient diagnosed by bone marrow core biopsy with hMDS - refractory anemia (FAB and WHO classification) with normal karyotype and scarce CD34(+) cells by immunohistophenotyping is presented. She was treated with androgens followed by CsA for a few months and shortly after she developed an acute myeloid leukemia (M4) which responded to low-doses of daily oral melphalan. This is one of the first few reports on such an event during the immunosuppressive therapy in MDS and the possible explanations for this unusual evolution are discussed.
Gologan
R
R
Clinic of Hematology, Fundeni Clinical Institute, Bucharest, Romania. rgologan@hades.ro
Ostroveanu
Daniela
D
Dobrea
Camelia
C
Gioadă
Liliana
L
D000208:Acute Disease; D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D016572:Cyclosporine / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007951:Leukemia, Myeloid / Q000188:drug therapy / Q000473:pathology; D008558:Melphalan / Q000627:therapeutic use; D009190:Myelodysplastic Syndromes / Q000473:pathology*; D017211:Treatment Failure
D018906:Antineoplastic Agents, Alkylating; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D008558:Melphalan