Erythropoietin-dependent transformation of myelodysplastic syndrome to acute monoblastic leukemia

Acute monoblastic leukemia (acute myeloid leukemia [AML], French-American-B ritish type M5a) with leukemia cutis developed in a patient 6 weeks after t he initiation of erythropoietin (EPO) therapy for refractory anemia with ri nged sideroblasts. AML disappeared from both marrow and skin after the disc ontinuation of EPO. Multiparameter flow cytometric analysis of bone marrow cells demonstrated coexpression of the EPO receptor with CD45 and CD13 on t he surface of blasts. The incubation of marrow cells with EPO, compared to without, resulted in 1.3- and 1.6-fold increases, respectively, in tritiate d thymidine incorporation and bromodeoxyuridine incorporation into CD13(+) cells. Clinical and laboratory findings were consistent with the EPO-depend ent transformation of myelodysplastic syndrome (MDS) to AML. It is conclude d that leukemic transformation In patients with MDS treated with EPO may be EPO-dependent and that management should consist of the discontinuation of EPO followed by observation, If clinically feasible. (Blood. 2001;98:3492- 3494) (C) 2001 by The American Society of Hematology.