Remission of acute myelogenous leukemia in elderly patients with prior refractory dysmyelopoietic anemia

Abstract

Refractory dysmyelopoietic anemia (RDA) is a myeloproliferative disorder usually of elderly patients which often evolves into acute myelogenous leukemia (AML). AML in such patients is usually considered untreatable with standard aggressive chemotherapy in part because these patients are often elderly, but primarily because of the concern that the bone marrow of these patients no longer has a residual stem cell to repopulate the bone marrow following chemotherapy‐induced aplasia. The authors treated three patients (ages 72, 69, and 62 years, respectively) with intensive chemotherapy after RDA evolved into AML. Each patient had been pancytopenic for 3 to 15 months prior to their transition to AML. At the onset of therapy for AML, all were severely pancytopenic with greater than 50% myeloblasts in the bone marrow. All patients had bone marrow aplasia by day 14 after chemotherapy with a complete bone marrow remission and normal peripheral counts by day 26. These data suggest that intensive chemotherapy of AML with prior RDA may result in complete bone marrow remission.

Intensive chemotherapy for acute non‐lymphoblastic leukemia after primary myelodysplastic syndrome

“…Data on the response to these therapies remain scarce and conflicting. A favourable outcome after intensive chemotherapy has been reported (Hussein et al, 1982;Murray et al, 1983;Yunis and Brunning, 1986), but other workers have observed poor responses (Mertelsmann et al, 1980;Tricot and Boogaerts, 1986). Low dose Ara-C has been disappointing in this indication (Tricot et al, 1984;Winter er al., 1985;Martiat et ai., 1986).…”

Translocation (2;11) (p21;q23) in acute non‐lymphocytic leukaemia: A non‐random association

“…Several treatment modalities with encouraging results have been proposed for myelodysplastic syndromes and subsequent acute non-lymphocytic leukaemias including retinoic acid ( 5 , 12), low dose cytosine arabinoside (13,14) and conventional doses of chemotherapy (15). Whether or not the t(2;ll) (p21;q23) will turn out to identify a subgroup of patients within the spectrum of myelodysplastic disorders and ANLL with respect to morphology of the malignant cell, clinical features, response to therapy, or prognosis, is not yet clear.…”