Familial erythroleukaemia: a cytogenetic and haematological study

Acute erythroleukemia: diagnosis and management

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. Treatment results for this disease are suboptimal and new drugs are needed. This article summarizes current knowledge in the field of acute erythroleukemia.

Familial erythroleukemia: a distinct clinical and genetic type of familial leukemias

A family with erythroleukemia is presented, in which father and son were diagnosed at the same age, but 20 years apart, with almost identical clinical and morphological features of the disease. No environmental factors were identified. The karyotypic abnormalities of the bone marrow blasts in the son demonstrated 2 major clones, involving chromosomes 5 and 7, as well as 8, 13, 16 and 21. Both patients demonstrated a poor response to chemotherapy. Previously described families with erythroleukemia are reviewed with available specific karyotypic aberrations.

Clinical and cytogenetic features of familial erythroleukaemia

A family is described in which six members developed acute nonlymphocytic leukaemia (ANLL) over the past 15 years, all morphologically FAB M6. Five affected individuals (ages 54-73) are members of a single sibship, the sixth (age 31) was the son of one of the affected sibs. The family lives in a rural area, and no environmental hazard has been identified. One of the six patients never resided in the same geographic area as the others. Three patients with leukaemia died without chemotherapy, two died shortly after the initiation of chemotherapy and the most recent patient never achieved remission, surviving 10 months. Bone marrow specimens from the two most recent patients were analysed for cytogenetic abnormalities using chromosome banding techniques. In addition, skin fibroblasts were examined in a single patient. The fibroblasts had a normal karyotype. Bone marrow cells from both patients had complex abnormalities. Some similarities were observed, including: hypodiploidy; loss of one chromosome 20; the presence of multiple marker chromosomes. In each case one marker appeared to involve the 'missing' no. 20 with an alteration of the long arm--loss (20q-) in one patient and gain (20q+) in the other. Peripheral blood lymphocytes were grown in folate deficient medium, but no evidence for folate sensitive fragile sites was found. Marrow chromosomes from a third leukaemic sibling were examined without banding techniques in 1976 and the karyotype was 45,XY,-18,-F(19 or 20), +marker. No specific cytogenetic finding was common to the three patients studied except for the loss of an F group chromosome. This family is unique in the literature with six cases of familial leukaemia of the same morphologic subtype, and the cytogenetic findings suggest that loss or rearrangement of part of the long arm of a single chromosome 20 may have occurred in each of the three patients examined.

Familial DiGuglielmo syndrome

DiGuglielmo syndrome is usually considered an idiopathic disorder occurring sporadically. A family in which DiGuglielmo syndrome occurred in 4 of 11 siblings is reported. A fifth sibling has developed unexplained marrow hypoplasia. Serial morphologic and cytochemical studies, supplemented by cytogenetic studies, documented the evolution of disease. Cytogenetic and environmental investigations did not explain this clustering of blood dyscrasias although a genetic predisposition to marrow damage by environmental factors cannot be excluded. The natural history of the disease in this sibship may consist of initial reactive changes in the marrow with subsequent progression to myelodysplasia with sideroblastosis and, finally, to DiGuglielmo syndrome.

Erythroleukemia: a study of 15 cases and literature review

Out of a total of 185 cases of acute leukemia at our institution from 1967 to 1978, fifteen cases (8.1%) were identified as erythroleukemia or erythremic myelosis. The symptoms at presentation were often related to anemia (10/15 cases); the presenting hemoglobin value was lower than 10.0 gm/100 ml. Nucleated red cells were present in the peripheral blood and reticulocyte response was inappropriate to the degree of anemia. Marrow biopsy showed erythroid hyperplasia with megaloblastic and dyserythropoietic features, increase in myeloblasts greater than 5% (10/15 cases), positive PAS staining of erythroid precursors (12/12 cases), and erythrophagocytosis by abnormal erythroid precursors (6/15 cases). Abnormalities were noted in monocytic and megakaryocytic cell lines, and it was concluded that erythroleukemia is probably a stem cell disorder. Response to chemotherapy was poor with median survival of four months from initial diagnosis. Intracranial hemorrhage and bacterial or fungal infection were the most frequent cause of death.