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1.
South Med J ; 107(8): 497-500, 2014 Aug.
Article in English | MEDLINE | ID: mdl-25084186

ABSTRACT

OBJECTIVE: We investigated an apparent increase in acute lymphoblastic leukemia (ALL) referrals from northern Georgia to a tertiary care center located in Atlanta. METHODS: Cases reported to the Georgia Comprehensive Cancer Registry and the national Surveillance Epidemiology and End Results cancer registry between 1999 and 2008 were analyzed. Age-adjusted incidence rates were calculated for all of the counties and public health regions and were compared with national rates calculated using Surveillance Epidemiology and End Results 17 data. Cases of adult acute myeloid leukemia served as controls. RESULTS: Age-adjusted incidence rates of adult ALL (0.8/100,000) and acute myeloid leukemia (4.6/100,000) were comparable to the national rates (0.9 and 5.2, respectively). The age-adjusted incidence rate of ALL in northern Georgia was 1.1 (95% confidence interval 0.8-1.5) and was not affected by race. CONCLUSIONS: The observed increase in cases of ALL at our tertiary center results from a referral pattern rather than heterogeneous distribution of adult ALL across Georgia.


Subject(s)
Leukemia, Erythroblastic, Acute/epidemiology , Adult , Georgia/epidemiology , Humans , Referral and Consultation , Registries
2.
Georgian Med News ; (163): 43-7, 2008 Oct.
Article in Russian | MEDLINE | ID: mdl-18997253

ABSTRACT

Erythroleukaemia (DI Guglielmo Desease) is a rare form of acute myeloid leukaemia. This pathology is extremely difficult to be diagnosed on the early stage. Acute erythroleukaemia may make its debut under the mask of haemolytic anaemia and can be acceptably suspected only after emergence of malignant cells in peripheral blood. In the paper is presented a case of 13 years old girl, who on the basis of anamnesis, clinical, and paraclinical data was diagnosed as having Autoimmune Haemolytic Anemia. As a result of prednisolone therapy full clinical and partial laboratory remission was achieved. A week later after stopping the treatment the patient was repeatedly hospitalized in very a bad condition, with blast cells in the peripheral blood (80% in bone marrow). According to morphological, cytochemical, immunological tests and cytogenetic analysis she was diagnosed as having Acute Erythroleukaemia.


Subject(s)
Anemia, Hemolytic, Autoimmune/diagnosis , Leukemia, Erythroblastic, Acute/diagnosis , Acute Disease , Adolescent , Anemia, Hemolytic, Autoimmune/epidemiology , Anemia, Hemolytic, Autoimmune/therapy , Anti-Inflammatory Agents/therapeutic use , Blood Transfusion/methods , Diagnosis, Differential , Female , Humans , Leukemia, Erythroblastic, Acute/epidemiology , Prednisolone/therapeutic use
3.
Blood ; 100(9): 3135-40, 2002 Nov 01.
Article in English | MEDLINE | ID: mdl-12384410

ABSTRACT

De novo erythroleukemia (EL) is a rare disease. Reported median survival are poor and vary from 4 to 14 months. The value of hematopoietic stem cell transplantation (HSCT) for EL is unknown. This EBMT registry study reports on the largest series of patients with EL treated with HSCT in first complete remission-103 autologous and 104 HLA identical sibling allogeneic HSCT. Outcome and identification of prognostic factors for each type of transplantation were evaluated. For autologous HSCT, outcome at 5 years showed a leukemia-free survival (LFS) of 26% +/- 5%, a relapse incidence (RI) of 70% +/- 6%, and a transplant-related mortality (TRM) of 13% +/- 4%. By multivariate analysis, the only prognostic factor was age. For allogeneic HSCT, outcome at 5 years showed an LFS of 57% +/- 5%, an RI of 21% +/- 5%, and a TRM of 27% +/- 5%. By multivariate analysis, prognostic factors were graft-versus-host disease and age. This study represents the largest series of de novo EL treated with HSCT and shows that allogeneic HSCT is by far the most effective treatment.


Subject(s)
Hematopoietic Stem Cell Transplantation , Leukemia, Erythroblastic, Acute/therapy , Acute Disease , Adolescent , Adult , Age Factors , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Combined Modality Therapy , Disease-Free Survival , Europe/epidemiology , Female , Follow-Up Studies , Hematopoietic Stem Cell Transplantation/adverse effects , Hematopoietic Stem Cell Transplantation/mortality , Histocompatibility , Humans , Incidence , Leukemia, Erythroblastic, Acute/drug therapy , Leukemia, Erythroblastic, Acute/epidemiology , Life Tables , Male , Middle Aged , Multivariate Analysis , Prognosis , Prospective Studies , Recurrence , Registries , Remission Induction , Siblings , Tissue Donors , Transplantation, Autologous , Transplantation, Homologous , Treatment Outcome
4.
Leukemia ; 16(8): 1399-401, 2002 Aug.
Article in English | MEDLINE | ID: mdl-12145675

ABSTRACT

The new WHO classification abolishes the frontier between RAEB-t with 20% of blasts and leukemia with 30% of blasts. We review the definitions of erythroleukemia and discuss the relationship between FAB AML6, RAEB-t and AML6 variant. We ask whether secondary erythroleukemias are the same entity as RAEB-t on survival, karyotype and cytologic characteristics. We suggest that 'AML6 variant' with pure erythroid lineage proliferation would be the real de novo erythroleukemia. Current FAB AML6 entity will probably be classified in either subgroup (1) multilineage dysplasia; (2) therapy-related leukemia; or (3) acute erythroid leukemia subdivided into erythroleukemia (erythroid/myeloid) and pure erythroid leukemia, in the WHO classification - a classification which highlights the importance of clinical and cytogenetic prognostic factors.


Subject(s)
Leukemia, Erythroblastic, Acute/classification , Adolescent , Adult , Aged , Anemia, Refractory, with Excess of Blasts/classification , Anemia, Refractory, with Excess of Blasts/pathology , Bone Marrow/pathology , Chromosome Aberrations , Chromosomes, Human/ultrastructure , Female , Humans , Immunophenotyping , Incidence , Karyotyping , Leukemia, Erythroblastic, Acute/epidemiology , Leukemia, Erythroblastic, Acute/genetics , Leukemia, Erythroblastic, Acute/pathology , Male , Middle Aged , Neoplasms, Second Primary/etiology , Neoplastic Stem Cells/pathology , Prognosis , Staining and Labeling , Terminology as Topic , Treatment Outcome , World Health Organization
5.
Haematologica ; 87(2): 148-53, 2002 Feb.
Article in English | MEDLINE | ID: mdl-11836165

ABSTRACT

BACKGROUND AND OBJECTIVES: 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. DESIGN AND 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. INTERPRETATION AND 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.


Subject(s)
Leukemia, Erythroblastic, Acute/pathology , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Bone Marrow/pathology , Cell Lineage , Chromosome Aberrations , Disease Progression , Erythrocytes, Abnormal/pathology , Female , Humans , Immunophenotyping , Karyotyping , Leukemia, Erythroblastic, Acute/blood , Leukemia, Erythroblastic, Acute/classification , Leukemia, Erythroblastic, Acute/epidemiology , Leukemia, Erythroblastic, Acute/genetics , Leukemia, Myeloid/blood , Leukemia, Myeloid/pathology , Male , Middle Aged , Myelodysplastic Syndromes/epidemiology , Periodic Acid-Schiff Reaction , Preleukemia/epidemiology , Spain/epidemiology , Survival Analysis
6.
Med Hypotheses ; 57(4): 465-8, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11601870

ABSTRACT

Using order parameters from field theory, the paper rationalizes the statistics of myeloid and erythroid leukemias more satisfactorily than the random mutation hypothesis. Adapted to B- and plasma cell lineages, the same arguments conceptualize the statistics of related malignancies congruently to clinical findings.


Subject(s)
Leukemia, Erythroblastic, Acute/epidemiology , Leukemia, Myeloid/epidemiology , Acute Disease , Cell Lineage , Chronic Disease , Humans , Incidence , Leukemia, Erythroblastic, Acute/pathology , Leukemia, Myeloid/pathology
7.
J Clin Pathol ; 54(8): 608-12, 2001 Aug.
Article in English | MEDLINE | ID: mdl-11477115

ABSTRACT

AIMS: To evaluate the incidence and outcome of acute myeloid leukaemia (AML), FAB M6 (erythroleukaemia). METHODS: A demographic study in the Northern Health Region of England between 1983 and 1999. RESULTS: Thirty three cases were diagnosed and registered prospectively. The overall incidence was 0.077 cases/100,000/year. There was a pronounced rise in incidence in patients aged 56 years or more: 6.6 times higher than that in younger patients. Overall survival was poor; median survival was 11 months for those aged less than 56 years, and three months for patients aged 56 years and above (p = 0.045). Acquired karyotypic abnormalities were found in 17 of 27 patients where analysis was attempted. When classified according to the criteria of the Medical Research Council AML trials, karyotype predicted survival, with a median overall survival of 14 months for those with "standard risk" cytogenetic results and two months for "poor risk" results (p = 0.005). CONCLUSION: This study demonstrates a worse survival for patients with erythroleukaemia than that reported in some published trials of selected patients.


Subject(s)
Leukemia, Erythroblastic, Acute/epidemiology , Adult , Age Distribution , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Child, Preschool , Cytarabine/administration & dosage , Cytogenetics , Daunorubicin/administration & dosage , England/epidemiology , Etoposide/administration & dosage , Female , Granulocyte Colony-Stimulating Factor/administration & dosage , Humans , Incidence , Leukemia, Erythroblastic, Acute/drug therapy , Male , Middle Aged , Prospective Studies , Risk , Survival Rate , Thioguanine/administration & dosage , Treatment Outcome , Vidarabine/administration & dosage , Vidarabine/analogs & derivatives
8.
Ann Hematol ; 68(6): 279-83, 1994 Jun.
Article in English | MEDLINE | ID: mdl-8038233

ABSTRACT

Conventional-dose Ara-C (200 mg/m2 d 1-5) combined with idarubicin (12 mg/m2 d 1-3) was employed as remission induction and consolidation therapy in 23 elderly AML patients with a median age of 66 years (range, 60-75) with AML according to the FAB criteria (M1 n = 3, M2 n = 10, M4 n = 6, M5 n = 2, M6 n = 2), eligible for the study. In seven patients earlier MDS had been documented by previous bone marrow aspirates. The CR rate after one induction course was 65% (15/23). Toxicity was acceptable, with four patients dying during the chemotherapy-induced hypoplasia (4/23). Although 80% of the CR patients received two additional cycles of Ara-C and idarubicin as consolidation therapy, only two patients are still in continuous complete remission more than 12 months after achieving CR. The median disease-free survival of the CR patients was 11.5 months and the median survival of the entire group was 10 months. We conclude that conventional dose Ara-C/idarubicin is an effective protocol for inducing complete remission in elderly patients with AML, but that consolidation therapy consisting of two courses of the same regimen does not produce a relevant rate of long-term disease-free survival.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cytarabine/administration & dosage , Idarubicin/administration & dosage , Leukemia, Myeloid/drug therapy , Acute Disease , Aged , Dose-Response Relationship, Drug , Humans , Leukemia, Erythroblastic, Acute/drug therapy , Leukemia, Erythroblastic, Acute/epidemiology , Leukemia, Monocytic, Acute/drug therapy , Leukemia, Monocytic, Acute/epidemiology , Leukemia, Myeloid/epidemiology , Leukemia, Myeloid, Acute/drug therapy , Leukemia, Myeloid, Acute/epidemiology , Leukemia, Myelomonocytic, Acute/drug therapy , Leukemia, Myelomonocytic, Acute/epidemiology , Middle Aged , Survival Analysis
9.
Blood Rev ; 6(4): 204-14, 1992 Dec.
Article in English | MEDLINE | ID: mdl-1486289

ABSTRACT

Erythroleukemia (EL) is a rare form of myelogenous leukemia the classification and definition of which has evolved over the course of its 80-year descriptive history. In 1976 the French American British (FAB) Cooperative Group included EL within the classification system of acute myelogenous leukemias as AML-M6, and agreed on a quantitative standard to be used in the diagnosis of this disorder. The standards were revised in 1985 to the form in use today. We selected a series of 15 cases from our records which specifically fit the FAB criteria for AML-M6. Extensive direct comparison between our series and the old literature is not practical because of the changes which have occurred in classification and definition of the disease. Overall we found a rough correlation between the clinical and laboratory data shown in the old literature on EL and data from our cases. These cases underscore characteristic laboratory features which correspond to what is now defined as AML-M6: these patients present with pancytopenia, frequent peripheral blood nRBCs and no, or few, peripheral blood blasts. In addition, we note the presence of a hybrid myeloid-erythroid blast in the bone marrow in this disease and suggest that this may be characteristic of this type of AML. Old literature on EL has generally shown it to be a disease of the elderly, yet we found a subset of younger patients whose clinical outcome was significantly better than that of the older patients. Finally, EL has historically been viewed as a disease in which patients progress from a prodrome through erythroleukemia to other acute myeloid leukemia (AML) subtypes. Consistent with this idea, half of our 15 patients had been previously diagnosed with myelodysplastic syndrome or received chemotherapy. On the other hand only one of the 15 patients converted to another type of AML during his course.


Subject(s)
Leukemia, Erythroblastic, Acute/epidemiology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Anemia/etiology , Biomarkers, Tumor , Bone Marrow/pathology , Chromosome Aberrations , Erythroid Precursor Cells/pathology , Female , Humans , Incidence , Leukemia, Erythroblastic, Acute/classification , Leukemia, Erythroblastic, Acute/complications , Leukemia, Erythroblastic, Acute/pathology , Male , Middle Aged , Myelodysplastic Syndromes/diagnosis , Myelodysplastic Syndromes/pathology , Retrospective Studies
10.
J Natl Cancer Inst ; 84(21): 1626-32, 1992 Nov 04.
Article in English | MEDLINE | ID: mdl-1433344

ABSTRACT

BACKGROUND: Epidemiologic studies of acute myeloid leukemias (AMLs) show small increases in risk of disease associated with certain occupations and chemical exposures. PURPOSE: This study was designed to determine whether the presence of mutationally activated ras oncogenes in AML are associated with occupational and chemical exposures. METHODS: We interviewed 62 patients with newly diagnosed AML (or their next-of-kin), all of whom were enrolled in a national multicenter clinical trial, and 630 healthy control subjects. DNA extracted from patients' pretreatment bone marrow samples was amplified by using the polymerase chain reaction and probed with allele-specific oligonucleotides for activating point mutations at the 12th, 13th, and 61st codons of three protooncogenes: H-ras (also known as HRAS), K-ras (also known as KRAS2), and N-ras (also known as NRAS). RESULTS: Patients with ras mutation-positive AML had a higher frequency (six of 10 patients) of working 5 or more years in an a priori high-risk occupation than did patients with ras mutation-negative AML (eight of 52; odds ratio [OR] = 6.8; 95% confidence interval [CI] = 1.3-36). Patients with ras mutation-positive AML were more likely than patients with ras mutation-negative AML to have breathed chemical vapor on the job (OR = 9.1; 95% CI = 1.3-64) or to have had skin contact with chemicals (OR = 6.9; 95% CI = 1.3-37). When ras-positive patients were compared with healthy control subjects, the ORs for occupation and occupational exposures remained elevated, while patients with ras mutation-negative AML showed no increased risk when compared with control subjects. CONCLUSION: Activation of ras proto-oncogenes may identify an etiologic subgroup of AML caused by occupation and chemical exposure. IMPLICATION: Disease etiology may be better understood if epidemiologic measures of exposure are integrated with molecular assays of the genetic defects responsible for cancer initiation and promotion.


Subject(s)
Gene Expression Regulation, Leukemic/genetics , Genes, ras/genetics , Leukemia, Myeloid/genetics , Occupational Exposure , Acute Disease , Adult , Aged , Case-Control Studies , Codon/drug effects , Codon/genetics , Female , Genes, ras/drug effects , Humans , Leukemia, Erythroblastic, Acute/chemically induced , Leukemia, Erythroblastic, Acute/epidemiology , Leukemia, Erythroblastic, Acute/genetics , Leukemia, Monocytic, Acute/chemically induced , Leukemia, Monocytic, Acute/epidemiology , Leukemia, Monocytic, Acute/genetics , Leukemia, Myeloid/chemically induced , Leukemia, Myeloid/epidemiology , Leukemia, Myeloid, Acute/chemically induced , Leukemia, Myeloid, Acute/epidemiology , Leukemia, Myeloid, Acute/genetics , Leukemia, Myelomonocytic, Acute/chemically induced , Leukemia, Myelomonocytic, Acute/epidemiology , Leukemia, Myelomonocytic, Acute/genetics , Male , Middle Aged , Mutation
12.
Cell Differ Dev ; 28(2): 129-33, 1989 Nov.
Article in English | MEDLINE | ID: mdl-2692787

ABSTRACT

When murine erythroleukemia (MEL) cells, having the transferred rat c-myc gene under the control of human metallothionein II gene promoter, are induced to differentiate with dimethyl sulfoxide (DMSO), the level of differentiation is dependent on the c-myc levels which are modulated by the Zn++ ion. The clonal transformant cell line (38-2) can continuously grow in the presence of both DMSO and Zn++ ion. The proportion of differentiated cells in a population of the continuous culture is strongly affected by the concentration of Zn++ ions. These results suggested that a balance between self-renewal and commitment to differentiation of MEL cells is determined by the c-myc level, and that this cell line may be suitable for studying the stochastic process of growth and differentiation of hemopoietic stem cells.


Subject(s)
Leukemia, Erythroblastic, Acute/pathology , Proto-Oncogene Proteins/genetics , Animals , Cell Line, Transformed , Dimethyl Sulfoxide/pharmacology , Gene Expression/genetics , Gene Expression Regulation, Neoplastic/drug effects , Leukemia, Erythroblastic, Acute/epidemiology , Leukemia, Erythroblastic, Acute/genetics , Mice , Probability , Proto-Oncogene Proteins/metabolism , Proto-Oncogene Proteins c-myc , Stochastic Processes , Transformation, Genetic/drug effects , Tumor Cells, Cultured/metabolism , Tumor Cells, Cultured/pathology
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