Myelodysplasia and leukaemia related to chemotherapy and/or radiotherapy-a haematological study of 13 cases. Value of macrocytosis as an early sign of bone marrow injury

Abstract

Clinical and haematological features of 13 patients with secondary myelodysplastic syndromes (MDS) were studied, MDS developed subsequent to chemotherapy and/or radiotherapy for various haematological or non-haematological diseases. In six cases, the first sign was a persistently increased mean cell volume (MCV) and a macrocytosis preceding from 6 to 18 months the appearance of severe anaemia or acute leukaemia. In five cases, the initial finding was a macrocytic anaemia. Dysmyelopoiesis was a constant and prominent feature of the bone marrow smears at some time during the course of the disease. Two cases without macrocytosis at any time directly developed overt acute leukaemia.

Natural history of smouldering leukaemia

“…We agree with Dohy et al (1980) that refractory macrocytosis is a frequent finding in pre-leukaemic marrow dysplasia, and should be accorded the same significance as an unexplained neutropenia or thrombocytopenia.…”

Sequential Appearance of Immunoblastic Lymphoma and Acute Nonlymphocytic Leukemia in a Patient with Angioimmunoblastic Lymphadenopathy

“…Although de novo ANLL may randomly occur in pa tients receiving chemotherapy, some characteristics are more frequently observed in secondary than in de novo leukemia, such as prior therapy with alkylating agents, a latency period ranging from 25 to 60 months after the start of therapy, the presence of certain nonramdom cytogenetic abnormalities, and the observa tion of a preleukemic phase [5]. The most outstanding features of such a preleukemic phase are macrocytosis and dyserythropoiesis, as it occurred in our patient, and the value of both signs as a herald of chemother apy-related myelodysplasia or leukemia has been stressed [9]. Secondary ANLL usually shows a poor therapeutic response [5,10].…”

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“…Secondary MDS, though essentially the same as idiopathic MDS has some characteristic features. Macrocytosis is an early feature (Dohy et al 1980), a far higher proportion of cases have cytogenetic abnormalities, the bone marrow is sometimes fatty and hypocellular, dyserythropoiesis is often the dominant feature, and diffuse sometimes dense reticulin increase is more common (Dohy ct al. 1980) though it does occur in idiopathic MDS as well (Sultan et al 1981).…”