title: Myelodysplastic syndromes following therapy with hypomethylating agents (HMAs): development of acute erythroleukemia may not influence assessment of treatment response.
abstract: This study followed 28 patients with myelodysplastic syndromes (MDS) who showed a rise of bone marrow (BM) erythroids to ≥ 50% following three cycles (1-60) of hypomethylating agent (HMA) therapy. If BM blasts were calculated as a percentage of non-erythroids, 12 (42.9%) patients met the diagnostic criteria for acute erythroleukemia, erythroid/myeloid (AEL). However, none of the patients showed clonal cytogenetic evolution or new mutations. When compared to 47 de novo AEL patients, these 12 patients were less anemic and thrombocytopenic, had less complex karyotypes (p = 0.044) and showed a longer survival, either calculated from diagnosis (p < 0.001) or from the time of AEL (p = 0.005). These findings illustrate that ≥ 50% erythroids may appear in BM post-HMA therapy, likely a combination of reduction of BM granulocytes (p < 0.001) and promotion of normal or abnormal erythroid proliferation. Enumeration of blasts as a percentage of non-erythroid cells may lead to a diagnosis of AEL and mis-interpretation as disease progression.
authors: a Department of Hematopathology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA ;
authors: Jie
authors: J
authors: Peng
authors: b Department of Pathology , Massachusetts General Hospital , Boston , MA , USA ;
authors: Robert P
authors: RP
authors: Hasserjian
authors: a Department of Hematopathology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA ;
authors: Guilin
authors: G
authors: Tang
authors: a Department of Hematopathology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA ;
authors: Keyur P
authors: KP
authors: Patel
authors: a Department of Hematopathology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA ;
authors: Maitrayee
authors: M
authors: Goswami
authors: c Department of Leukemia , The University of Texas MD Anderson Cancer Center , Houston , TX , USA.
authors: Elias J
authors: EJ
authors: Jabbour
authors: c Department of Leukemia , The University of Texas MD Anderson Cancer Center , Houston , TX , USA.
authors: Guillermo
authors: G
authors: Garcia-Manero
authors: a Department of Hematopathology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA ;
authors: L Jeffrey
authors: LJ
authors: Medeiros
authors: a Department of Hematopathology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA ;
authors: Sa A
authors: SA
authors: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001374:Azacitidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology; D002869:Chromosome Aberrations; D019175:DNA Methylation / Q000187:drug effects*; D000077209:Decitabine; D005260:Female; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D004915:Leukemia, Erythroblastic, Acute / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000188:drug therapy* / Q000235:genetics* / Q000401:mortality; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D000077209:Decitabine; D001374:Azacitidine
keywords: Acute erythroid leukemia; erythroid predominance; hypomethylating agents; myelodysplastic syndrome; therapy