Acute erythro leukemia

Overview

Acute erythroleukemia is a rare subtype of acute myeloid leukemia that has undergone several changes in classification over the past 30 years. There are two subtypes of acute erythroleukemia: the more common erythroid/myeloid subtype, defined by the presence of increased erythroid cells and myeloid blasts; and the rarer, pure erythroid subtype, characterized by expansion of immature erythroid cells only. The erythroid/myeloid subtype of acute erythroleukemia is closely related to acute myeloid leukemia with myelodysplasia-related changes, and is frequently characterized by morphological dysplasia and complex karyotype. Pure erythroleukemia is a very uncommon subtype of leukemia associated with a very poor response and survival to current available therapeutic agents.

Symptoms

  • Tiredness
  • Fatigue
  • Breathing difficulty
  • Pallor - due to anemia
  • Thrombocytopenia
  • Nose bleeds
  • Weight loss
  • Easy bruising
  • Fever
  • Abdominal pain
  • Anemia
  • Bleeding gums
  • Bleeding into the retina
  • Joint pain
  • Respiratory tract infections
  • Urinary tract infections
  • Sinus infections
  • Skin infections
  • Infections around rectal area
  • Enlarged lymph nodes
  • Neutropenia

Causes

The most common predisposing factors in secondary acute erythroleukemia are as follows:

  • Myelodysplastic syndrome (MDS) is a predisposing factor.
  • Ionizing radiation: Thorotrast, a radiographic contrast medium used in the 1940s, is associated with increased risk of erythroleukemia (latent period of 10-30 y after exposure).
  • Prior chemotherapy, such as with alkylating agents, is a predisposing factor. These agents may be used in the treatment of Hodgkin disease, multiple myeloma, bone marrow transplant, ovarian and breast cancer, and nonneoplastic disorders (eg, collagen vascular disease).
  • Rare cases of familial erythroleukemia (autosomal dominant with variable penetrance) have been described, which manifest in the sixth decade of life.

Prognosis

The prognosis of acute erythroid leukaemia is reported as poor. It is, however, important to differentiate de novo from secondary or therapy related erythroid leukaemia, where the later have a worse prognosis. Remission induction for de novo disease is similar to other subtypes of AML, however the poor outcome has been linked to short remission duration.

Treatment

The treatment for acute erythroleukemia is usually similar to the approach used for acute myelogenous leukemia. The patient is usually kept on a diet of cooked fruit and vegetables. Usually, they are asked to avoid strenuous physical activity and pay special attention to oral hygiene. What makes the treatment difficult is the multi-drug resistance gene expression, which is responsible for poor response to chemotherapy and consequently, a short survival time. Often, physicians recommend placing an indwelling central venous catheter and port for chemotherapy infusion, which is also used to draw blood samples for periodic analysis.