title: Erythroleukemia shares biological features and outcome with myelodysplastic syndromes with excess blasts: a rationale for its inclusion into future classifications of myelodysplastic syndromes.
abstract: Erythroleukemia was considered an acute myeloid leukemia in the 2008 World Health Organization (WHO) classification and is defined by the presence of ≥50% bone marrow erythroblasts, having <20% bone marrow blasts from total nucleated cells but ≥20% bone marrow myeloblasts from nonerythroid cells. Erythroleukemia shares clinicopathologic features with myelodysplastic syndromes, especially with erythroid-predominant myelodysplastic syndromes (≥50% bone marrow erythroblasts). The upcoming WHO revision proposes to eliminate the nonerythroid blast cell count rule and to move erythroleukemia patients into the appropriate myelodysplastic syndrome category on the basis of the absolute blast cell count. We conducted a retrospective study of patients with de novo erythroleukemia and compared their clinico-biological features and outcome with those of de novo myelodysplastic syndromes, focusing on erythroid-predominant myelodysplastic syndromes. Median overall survival of 405 erythroid-predominant myelodysplastic syndromes without excess blasts was significantly longer than that observed in 57 erythroid-predominant refractory anemias with excess blasts-1 and in 59 erythroleukemias, but no significant difference was observed between erythroid-predominant refractory anemias with excess blasts-1 and erythroleukemias. In this subset of patients with ≥50% bone marrow erythroblasts and excess blasts, the presence of a high-risk karyotype defined by the International Prognostic Scoring System or by the Revised International Prognostic Scoring System was the main prognostic factor. In the same way, the survival of 459 refractory anemias with excess blasts-2, independently of having ≥20% bone marrow blasts from nonerythroid cells or not, was almost identical to the observed in 59 erythroleukemias. Interestingly, 11 low-blast count erythroleukemias with 5 to <10% bone marrow blasts from total nucleated cells showed similar survival than the rest of erythroleukemias. Our data suggest that de novo erythroleukemia is in the spectrum of myelodysplastic syndromes with excess blasts and support its inclusion into future classifications of myelodysplastic syndromes.
authors: Laboratorio Citología Hematológica. Servicio Patología, GRETNHE, IMIM Hospital del Mar Research Institute, Hospital del Mar, Barcelona, Spain.
authors: Xavier
authors: 0000-0001-7934-9130
authors: X
authors: Calvo
authors: Laboratorio Citología Hematológica. Servicio Patología, GRETNHE, IMIM Hospital del Mar Research Institute, Hospital del Mar, Barcelona, Spain.
authors: Leonor
authors: L
authors: Arenillas
authors: Servicio Hematología, Hospital Universitario Central Asturias, Oviedo, Spain.
authors: Elisa
authors: E
authors: Luño
authors: Servicio Hematología, Hospital Universitario La Fe, Valencia, Spain.
authors: Leonor
authors: L
authors: Senent
authors: Servicio Hematología, ICO-Hospitalet de Llobregat, Barcelona, Spain.
authors: Montserrat
authors: M
authors: Arnan
authors: Servicio Hematología, Hospital Universitario de León, León, Spain.
authors: Fernando
authors: F
authors: Ramos
authors: Servicio Hematología, Hospital Universitario Txagorritxu, Vitoria, Spain.
authors: María Teresa
authors: MT
authors: Ardanaz
authors: Servicio Hematología, IMIM Hospital del Mar Research Institute, Barcelona, Spain.
authors: Carme
authors: C
authors: Pedro
authors: Servicio Hematología, Hospital Clínico Universitario de Valencia, Valencia, Spain.
authors: Mar
authors: M
authors: Tormo
authors: Servicio Hematología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors: Julia
authors: J
authors: Montoro
authors: Servicio Hematología, Hospital Universitario de Salamanca, Salamanca, Spain.
authors: María
authors: M
authors: Díez-Campelo
authors: Servicio Hematología, Hospital Universitario Cruces, Baracaldo, Spain.
authors: Beatriz
authors: B
authors: Arrizabalaga
authors: Servicio Hematología, ICO-Badalona, Badalona, Spain.
authors: Blanca
authors: B
authors: Xicoy
authors: Servicio Hematología, Hospital La Ribera, Alzira, Spain.
authors: Santiago
authors: S
authors: Bonanad
authors: Servicio Hematología y Oncología Médica, Hospital Morales Meseguer, IMIB-Arrixaca, Murcia, Spain.
authors: Andrés
authors: A
authors: Jerez
authors: Servicio Hematología, Hospital Clínic, Barcelona, Spain.
authors: Benet
authors: B
authors: Nomdedeu
authors: Laboratorio Citología Hematológica. Servicio Patología, GRETNHE, IMIM Hospital del Mar Research Institute, Hospital del Mar, Barcelona, Spain.
authors: Ana
authors: A
authors: Ferrer
authors: Servicio Hematología, Hospital Universitario La Fe, Valencia, Spain.
authors: Guillermo F
authors: GF
authors: Sanz
authors: Laboratorio Citología Hematológica. Servicio Patología, GRETNHE, IMIM Hospital del Mar Research Institute, Hospital del Mar, Barcelona, Spain.
authors: Lourdes
authors: L
authors: Florensa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D004915:Leukemia, Erythroblastic, Acute / Q000145:classification* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000401:mortality / Q000473:pathology*; D012189:Retrospective Studies