Erythroleukemia Clinical Presentation

  • Author: Beata Holkova, MD; Chief Editor: Emmanuel C Besa, MD   more...
 
Updated: Jul 14, 2011
 

History

At presentation, the signs and symptoms of erythroleukemia are usually nonspecific and are attributable to the decreased hematopoiesis resulting from the replacement of bone marrow by leukemic cells. This decrease results in anemia, thrombocytopenia, and leukopenia.

Patients rarely present with symptoms lasting longer than 6 months, and they are usually diagnosed within 1-3 months after the onset of symptoms. The most common presenting symptoms are as follows:

  • Fatigue or malaise
  • Minimal-to-modest weight loss
  • Easy bruising
  • Fever
  • Bone or abdominal pain
  • Dyspnea
  • Meningeal signs and symptoms (very rare, only if leukemic involvement of the central nervous system [CNS] is present)
  • Diffuse joint pain (nonspecific in one third of patients)
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Physical

Physical examination findings may include the following:

  • Pallor (anemia)
  • Hemorrhage (thrombocytopenia) - Ecchymoses or petechiae; gum bleeding; epistaxis; retinal hemorrhage
  • Fever and infection (neutropenia) - Respiratory tract, urinary tract, sinuses, perirectal area, or skin
  • Hepatosplenomegaly (< 25% of cases)
  • Lymphadenopathy
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Complications

Complications may include opportunistic infections and neutropenic fever, tumor lysis syndrome (ie, hyperuricemia, hyperkalemia, hyperphosphatemia), and bleeding.

Infections, even if properly treated, may be fatal. Recognizing patients who are at risk for tumor lysis syndrome (high tumor burden, elevated uric acid) is important. Intravenous hydration and allopurinol should be started before chemotherapy, and serum electrolytes and renal function should be monitored. Patients who have received multiple platelet transfusions may become refractory. To reduce alloimmunization, single-donor platelets or human leukocyte antigen (HLA)-matched platelets with leukocyte reduction filters should be used.

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Contributor Information and Disclosures
Author

Beata Holkova, MD  Assistant Professor, Massey Cancer Center, Medical College of Virginia, Virginia Commonwealth University School of Medicine

Beata Holkova, MD is a member of the following medical societies: American College of Physicians and American Society of Hematology

Disclosure: Nothing to disclose.

Coauthor(s)

Asher A Chanan-Khan, MD  Assistant Professor, Department of Medicine, Division of Lymphoma and Bone Marrow Transplantation, Roswell Park Cancer Institute, State University of New York at Buffalo

Asher A Chanan-Khan, MD is a member of the following medical societies: American College of Physicians, American Medical Association, and American Society of Hematology

Disclosure: Nothing to disclose.

Kenichi Takeshita, MD  Adjunct Associate Professor, Department of Medicine, Division of Hematology, New York University School of Medicine; Medical Director, Clinical Research and Development, Celgene

Kenichi Takeshita, MD is a member of the following medical societies: American Society of Hematology

Disclosure: Nothing to disclose.

Specialty Editor Board

David Aboulafia, MD  Medical Director, Bailey-Boushay House, Clinical Professor, Department of Medicine, Division of Hematology, Attending Physician, Section of Hematology/Oncology, Virginia Mason Clinic; Investigator, Virginia Mason Community Clinic Oncology Program/SWOG

David Aboulafia, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Medical Directors Association, American Society of Hematology, Infectious Diseases Society of America, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Chief Editor

Emmanuel C Besa, MD  Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Clinical Oncology, American Society of Hematology, and New York Academy of Sciences

Disclosure: Nothing to disclose.

References

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  2. Mazzella FM, Kowal-Vern A, Shrit MA, et al. Effects of multidrug resistance gene expression in acute erythroleukemia. Mod Pathol. Apr 2000;13(4):407-13. [Medline].

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  4. Kowal-Vern A, Mazzella FM, Cotelingam JD, et al. Diagnosis and characterization of acute erythroleukemia subsets by determining the percentages of myeloblasts and proerythroblasts in 69 cases. Am J Hematol. Sep 2000;65(1):5-13. [Medline].

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  8. Cuneo A, Van Orshoven A, Michaux JL, et al. Morphologic, immunologic and cytogenetic studies in erythroleukaemia: evidence for multilineage involvement and identification of two distinct cytogenetic-clinicopathological types. Br J Haematol. Jul 1990;75(3):346-54. [Medline].

  9. McHayleh W, Sehgal R, Redner RL, Raptis A, Agha M, Natale J, et al. Mitoxantrone and etoposide in patients with newly diagnosed acute myeloid leukemia with persistent leukemia after a course of therapy with cytarabine and idarubicin. Leuk Lymphoma. Oct 8 2009;[Medline].

  10. Mayer RJ, Davis RB, Schiffer CA, et al. Intensive postremission chemotherapy in adults with acute myeloid leukemia. Cancer and Leukemia Group B. N Engl J Med. Oct 6 1994;331(14):896-903. [Medline].

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Bone marrow aspirate showing erythroblasts in a patient with erythroleukemia. Courtesy of Maurice Barcos, MD, PhD, Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY.
 
 
 
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