LEUKOERYTHROBLASTIC ANEMIA IN METASTATIC PROSTATE-CANCER - CLINICAL AND PROGNOSTIC-SIGNIFICANCE IN PATIENTS WITH HORMONE-REFRACTORY DISEASE

Background. The clinical and prognostic significance of leukoerythrobl astic anemia (LKEA) in patients with metastatic prostate cancer and, i n general, patients with disseminated solid tumors is poorly understoo d. Therefore, the authors studied a population of patients with metast atic prostate cancer refractory to hormonal therapy to assess the inci dence, clinical features, and prognostic implications of LKEA. Methods . The medical records of 106 patients with hormone-refractory prostate cancer metastatic to bone seen at the Tucson Veterans Affairs Medical Center between 1985 and 1991 were reviewed retrospectively. The clini cal and laboratory data, number of packed erythrocyte transfusions req uired, and length of survival from the time of diagnosis of hormone-re fractory disease until last follow-up visit or death were investigated in 91 identified patients. Results. Twenty-six of 91 patients (28.6%) were found to have LKEA. LKEA developed before or at the time of diag nosis of hormone-refractory disease in 8 patients and after diagnosis of hormone-refractory disease in 18 patients. The presence of LKEA was associated with significantly lower hemoglobin levels and platelet (P lt) counts and significantly higher total bilirubin, lactic dehydrogen ase (LDH), and alkaline phosphatase values (P < 0.05). Leukopenia (< 4 .0 X 10(9)/l leukocytes), thrombocytopenia (< 150 X 10(9)/l Plt), elev ated LDH levels (> 220 U/l), and laboratory evidence of disseminated i ntravascular coagulation (DIC) were more common in patients with LKEA than in those without LKEA (P < 0.01). Microangiopathic hemolysis was seen in only 2 of 91 patients (2.1%). Patients with LKEA had significa ntly greater transfusion requirements compared with patients without L KEA (P < 0.0001), but the median survival length was not significantly different (9 months versus 11 months, respectively). The presence of DIC and LDH levels of 500 U/l or greater in patients with LKEA was ass ociated with a poor prognosis. Conclusions. LKEA is a relatively commo n finding in patients with hormone-refractory metastatic prostate canc er and is associated with greater transfusion requirements. Its presen ce, however, does not affect survival significantly.