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375 Iron chelation therapy – case report
Abstracts for Publication / Leukemia Research 35 (2011) S143–S150
One patient with diagnosis of MDS-INT-1 progress to leukemia in five months, we intend to discuss the time of beginning treatment with hypomethylation agents and the indications of transplant. We propose that this parameters could be used as a complement in classification of subgroups of MDS and suggest a prognostic score to grade our treatment decision. Lower Risk MDS – proposed prognostic model score 1. CD34 by immunocytochemistry: 2 2. Fibrosis Grau 1: 1 3. Fibrosis Grau 2 or 3: 2 4. Nodules lymphoid: 1 5. Alteration in vasculature: 1 We think that patients with score of 02 points or more, could a have a evolution more agressive and should be evaluated to earlier treatment. Of course it needs a validation in a large prospective randomized study, and at this moment it only could be used as a complement in the classification that we have. 374 Acute erythroid leukemia, a disease akin to myelodysplastic syndrome rather than acute myeloid leukemia C.-J. Liu1 , Y.-C. Hong1 , C.-F. Yang2 , C.-H. Tzeng1 . 1 Division of Hematology and Oncology, Department of Medicine, 2 Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan R.O.C. Background: Acute erythroid leukemia (M6) is a rare subtype of acute myeloid leukemia for which the World Health Organization (WHO) revised the classification in 2008. We determined the effects of these changes on acute erythroid leukemia over the past 10 years. Material and Methods: We applied the 2008 revised WHO classification to the 2092 patients diagnosed with myelodysplastic syndrome or acute myeloid leukemia at Taipei Veterans General Hospital from January 2000 to April 2010. Only 67 patients met the criteria of the 2008 revision for acute erythroid leukemia. We reviewed clinico-pathological features, management, and outcomes of these patients. Results: The characteristics, laboratory, pathological, and cytogenetic findings of acute erythroid leukemia resembled myelodysplastic syndrome rather than acute myeloid leukemia. Patients with poor performance status, advanced anemia, and International Prognostic Scoring System(IPSS)high-risk scores had significantly inferior outcomes.
IPSS score has good predictive value for prognosis.
S149
Multivariate analysis of overall survival of acute ECOG 3–4 Albumin <37 g/L Ferritin ≥900 ng/mL Lactate dehydrogenase ≥300 U/L Hemoglobin <80 g/l IPSS high risk category (≥2.5)
Univariate P value
Multivariate HR (95% CI)
Multivariate P value
.013 .009 .021 .005 .002 .034
3.8–925.6 0.8–7.7 0.8–7.6 0.7–5.9 1.2–80.3 1.8–19.5
.004* .136 .134 .230 .034* .004*
Conclusion: Acute erythroid leukemia shares many clinical features with myelodysplastic syndrome including cytogenetic abnormalities, risk stratification, and outcomes. The IPSS scoring system has good predictive value for prognosis. 375 Iron chelation therapy – case report ˇ D. Celeketi c, ´ Z. Petrovic, ´ Z. Cvetkovic. ´ Medical Faculty University of Belgrade Clinical Hospital Center Zemun, Belgrade, Serbia Background: Myelodysplastic syndrome (MDS) is composed of a group of hematologically and prognostically diverse hematopoietic stem cell malignancies characterized by ineffective blood cell production. Myelodysplastic syndromes (MDS) mainly characterized by bone marrow blasts up to 20%, one or more peripheral cytopenias and bone marrow dysplasia. MDS frequently characterized by anemia and transfusion dependency. Transfusion dependency can be long lasting, leading to iron overload. This is defined as the chelatable iron, able to reach tissues and cells, and is thought to be responsible for tissue damage, fibrosis and organ failure, mainly affecting the liver, heart and pancreas, leading to secondary hemochromatosis. Iron chelation therapy reduces iron load as measured by changes in serum ferritin and may be a therapeutic option for these patients, especially since the approval of oral iron chelators, which are easier to use and better accepted by the patients and may prolong overall survival. Purpose: To present the therapeutic effects of oral chelators in patient with MDS 5q Sy at the beginning of transfusion dependency and at the moment when the transfusion dependency were more frequently than 2–3 times per month. Patients and metods: Female patient, 50 years old, Dg Myelodysplastic syndrome 5q Sy were diagnosed at 2006 year. From the beginning patient required red blood cell transfusions, at the start that was one or two transfusion in 3–4 months. During the period of 3 years and long lasting transfusion dependency leads to iron overload and manifests with clinical sequelae. Results: After 3 years of transfusion dependency level of serum ferritin was high, 2840.7 ng/mL and patient were treated with oral iron chelators, in a dose of 20 mg/kg/day. Serum ferritin reduced at 2619.0 ng/mL for the first month of therapy. As the patient was more transfusion dependent, with manifest clinical sequele, with 2–3 transfusions per month, ferritin levels up at 3745.3 ng/mL. The therapy with oral iron chelators continued. The therapeutic effect was lower than at the beginning of treatment (ferritin levels from 3745.3 ng/mL to 3630.5 ng/mL) during the second and third months of treatment. Conclusion: Iron chelation therapy, in our experience, shows better results when the transfusion therapy were less frequent, at the beginning of treatment MDS. As the transfusion dependency increased the therapeutical effects of iron chelation therapy was lower. Careful attention to iron parameters, with early initiation of iron chelation in patients is an important component of high-quality MDS patient care.
One patient with diagnosis of MDS-INT-1 progress to leukemia in five months, we intend to discuss the time of beginning treatment with hypomethylation agents and the indications of transplant. We propose that this parameters could be used as a complement in classification of subgroups of MDS and suggest a prognostic score to grade our treatment decision. Lower Risk MDS – proposed prognostic model score 1. CD34 by immunocytochemistry: 2 2. Fibrosis Grau 1: 1 3. Fibrosis Grau 2 or 3: 2 4. Nodules lymphoid: 1 5. Alteration in vasculature: 1 We think that patients with score of 02 points or more, could a have a evolution more agressive and should be evaluated to earlier treatment. Of course it needs a validation in a large prospective randomized study, and at this moment it only could be used as a complement in the classification that we have. 374 Acute erythroid leukemia, a disease akin to myelodysplastic syndrome rather than acute myeloid leukemia C.-J. Liu1 , Y.-C. Hong1 , C.-F. Yang2 , C.-H. Tzeng1 . 1 Division of Hematology and Oncology, Department of Medicine, 2 Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan R.O.C. Background: Acute erythroid leukemia (M6) is a rare subtype of acute myeloid leukemia for which the World Health Organization (WHO) revised the classification in 2008. We determined the effects of these changes on acute erythroid leukemia over the past 10 years. Material and Methods: We applied the 2008 revised WHO classification to the 2092 patients diagnosed with myelodysplastic syndrome or acute myeloid leukemia at Taipei Veterans General Hospital from January 2000 to April 2010. Only 67 patients met the criteria of the 2008 revision for acute erythroid leukemia. We reviewed clinico-pathological features, management, and outcomes of these patients. Results: The characteristics, laboratory, pathological, and cytogenetic findings of acute erythroid leukemia resembled myelodysplastic syndrome rather than acute myeloid leukemia. Patients with poor performance status, advanced anemia, and International Prognostic Scoring System(IPSS)high-risk scores had significantly inferior outcomes.
IPSS score has good predictive value for prognosis.
S149
Multivariate analysis of overall survival of acute ECOG 3–4 Albumin <37 g/L Ferritin ≥900 ng/mL Lactate dehydrogenase ≥300 U/L Hemoglobin <80 g/l IPSS high risk category (≥2.5)
Univariate P value
Multivariate HR (95% CI)
Multivariate P value
.013 .009 .021 .005 .002 .034
3.8–925.6 0.8–7.7 0.8–7.6 0.7–5.9 1.2–80.3 1.8–19.5
.004* .136 .134 .230 .034* .004*
Conclusion: Acute erythroid leukemia shares many clinical features with myelodysplastic syndrome including cytogenetic abnormalities, risk stratification, and outcomes. The IPSS scoring system has good predictive value for prognosis. 375 Iron chelation therapy – case report ˇ D. Celeketi c, ´ Z. Petrovic, ´ Z. Cvetkovic. ´ Medical Faculty University of Belgrade Clinical Hospital Center Zemun, Belgrade, Serbia Background: Myelodysplastic syndrome (MDS) is composed of a group of hematologically and prognostically diverse hematopoietic stem cell malignancies characterized by ineffective blood cell production. Myelodysplastic syndromes (MDS) mainly characterized by bone marrow blasts up to 20%, one or more peripheral cytopenias and bone marrow dysplasia. MDS frequently characterized by anemia and transfusion dependency. Transfusion dependency can be long lasting, leading to iron overload. This is defined as the chelatable iron, able to reach tissues and cells, and is thought to be responsible for tissue damage, fibrosis and organ failure, mainly affecting the liver, heart and pancreas, leading to secondary hemochromatosis. Iron chelation therapy reduces iron load as measured by changes in serum ferritin and may be a therapeutic option for these patients, especially since the approval of oral iron chelators, which are easier to use and better accepted by the patients and may prolong overall survival. Purpose: To present the therapeutic effects of oral chelators in patient with MDS 5q Sy at the beginning of transfusion dependency and at the moment when the transfusion dependency were more frequently than 2–3 times per month. Patients and metods: Female patient, 50 years old, Dg Myelodysplastic syndrome 5q Sy were diagnosed at 2006 year. From the beginning patient required red blood cell transfusions, at the start that was one or two transfusion in 3–4 months. During the period of 3 years and long lasting transfusion dependency leads to iron overload and manifests with clinical sequelae. Results: After 3 years of transfusion dependency level of serum ferritin was high, 2840.7 ng/mL and patient were treated with oral iron chelators, in a dose of 20 mg/kg/day. Serum ferritin reduced at 2619.0 ng/mL for the first month of therapy. As the patient was more transfusion dependent, with manifest clinical sequele, with 2–3 transfusions per month, ferritin levels up at 3745.3 ng/mL. The therapy with oral iron chelators continued. The therapeutic effect was lower than at the beginning of treatment (ferritin levels from 3745.3 ng/mL to 3630.5 ng/mL) during the second and third months of treatment. Conclusion: Iron chelation therapy, in our experience, shows better results when the transfusion therapy were less frequent, at the beginning of treatment MDS. As the transfusion dependency increased the therapeutical effects of iron chelation therapy was lower. Careful attention to iron parameters, with early initiation of iron chelation in patients is an important component of high-quality MDS patient care.