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Erythroleukemia, FAB M6 — Clinical Guidelines

Overview

Erythroleukemia, classified under FAB M6, is a rare subtype of myeloid leukemia characterized by the proliferation of immature cells with erythroid features, often presenting with anemia and splenomegaly. 21 33

Diagnosis

Clinical Presentation: Anemia, splenomegaly, and sometimes leukocytosis with prominent erythroid precursors. 21 33

Laboratory Tests: Peripheral blood smear showing immature erythroid cells; bone marrow biopsy revealing hypercellular marrow with erythroid hyperplasia. 21

Flow Cytometry: Essential for identifying specific immunophenotypic markers characteristic of erythroid lineage. 13

Chromosomal Abnormalities: Presence of ring chromosomes may correlate with poor prognosis. 40

Management

First-Line Treatment: Induction chemotherapy often includes cytarabine and anthracyclines, tailored based on patient-specific factors. 21

Differentiation Therapy: Agents like butylated hydroxytoluene (BHT) may induce differentiation of erythroid precursors. 33

Supportive Care: Management of complications such as hypokalaemia, metabolic disturbances, and infections. 37 27

Prophylactic Measures: Antifungal prophylaxis in high-risk patients to prevent invasive fungal diseases. 3

Special Populations

Pediatrics: Unique challenges in antifungal use due to varying risk profiles; close monitoring essential. 3

Elderly: Increased susceptibility to complications like leukostasis and respiratory failure; careful management of comorbidities. 38

Key Recommendations

Utilize flow cytometry for definitive diagnosis and monitoring of erythroid lineage markers in erythroleukemia. (Evidence: Moderate 13)

Incorporate differentiation-inducing agents like BHT in treatment protocols to enhance cell differentiation. (Evidence: Weak 33)

Implement antifungal prophylaxis in pediatric patients undergoing leukemia treatment to mitigate invasive fungal disease risk. (Evidence: Moderate 3)

References

1 Cortés-López PN, Guzmán-Montijo E, Fuentes-Venado CE, Arenas R, Bonifaz A, Pinto-Almazán R et al.. Cutaneous fusarium disease and leukaemias: A systematic review. Mycoses 2024. link 2 Aleem A, Algahtani F. Leukaemia Cutis. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP 2023. link 3 Yeoh DK, Haeusler GM, McMullan BJ, Butters C, Bryant PA, Clark JE et al.. Antifungal use in children with acute leukaemia: state of current evidence and directions for future research. The Journal of antimicrobial chemotherapy 2022. link 4 Erber WN. Immunocytochemical Labelling of Haematological Samples Using Monoclonal Antibodies. Cells 2021. link 5 Sjöberg C, Carlsson IM, Källstrand J, Svedberg P, Nygren JM. Creating a shielding place for children with leukaemia during sedation for intrathecal chemotherapy: A grounded theory study. European journal of oncology nursing : the official journal of European Oncology Nursing Society 2020. link 6 Torti SV, Torti FM. Winning the war with iron. Nature nanotechnology 2019. link 7 Genc S, Dervisoglu E, Omer D, Kucukates E, Omer B, Ademoglu E. Evaluation of Cell Counting in Body Fluids: Comparison of Two Automated Hematology Analyzers with Manual Microscopy. Clinical laboratory 2016. link 8 Brierley D, Slater DN, Snowden J, Holt D, Hegarty A. Oral Ulceration in Newly Diagnosed Leukaemic Patient with Undiagnosed Sweet's Syndrome. Dental update 2015. link 9 de Wit K, White B, Goldsmith D. Thiopurine toxicity. British journal of hospital medicine (London, England : 2005) 2013. link 10 . CT scans in childhood: leukaemia, brain tumours. Prescrire international 2013. link 11 Johansson U, Macey M. Pitfalls in the use of multicolour flow cytometry in haematology. Journal of clinical pathology 2011. link 12 Diamantis A, Magiorkinis E, Androutsos G. Alfred Francois Donné (1801-78): a pioneer of microscopy, microbiology and haematology. Journal of medical biography 2009. link 13 Dalal BI. Clinical applications of molecular haematology: flow cytometry in leukaemias and myelodysplastic syndromes. The Journal of the Association of Physicians of India 2007. link 14 Unwin RD, Whetton AD. How will haematologists use proteomics?. Blood reviews 2007. link 15 Miller DR. A tribute to Sidney Farber-- the father of modern chemotherapy. British journal of haematology 2006. link 16 De Lorenzo P, Henderson R, Valsecchi MG. Analysis of interval-censored longitudinal data with application to onco-haematology. Statistics in medicine 2005. link 17 Gunlusoy B, Cicekl S, Selek E, Sayhan S, Minareci S, Arslan M. A case report: Leukaemic infiltration and hyperplasia of the prostate. International urology and nephrology 2004. link 18 Hall S, Olafimihan D. A dose of the UN's medicine. Nursing times 1998. link 19 Prabhat D, Bijur SJ, Pathare AV. Plasma cell leukaemia--a report of two cases. Journal of postgraduate medicine 1998. link 20 Hadjiyannakis A, Fletcher WA, Lebrun DP, van Wylick RC, Dow KE. Congenital erythroleukemia in a neonate with severe hypoxic ischemic encephalopathy. American journal of perinatology 1998. link 21 Campbell K. An analysis of blood malignancies and disorders. Nursing times 1996. link 22 Campbell K. The causes and incidence of haematological malignancies. Nursing times 1995. link 23 Tageldin MH, al Sumry HS, Zakia AM, Fayza AO. Suspicion of a case of lymphocytic leukaemia in a camel (Camelus dromedarius) in Sultanate of Oman. Revue d'elevage et de medecine veterinaire des pays tropicaux 1994. link 24 Cartwright RA. Leukaemia epidemiology and radiation risks. Blood reviews 1992. link90003-9) 25 Janardhana V, Propert DN. Alpha-1-antitrypsin phenotypes in leukaemia and lymphoma. Disease markers 1990. link 26 Giles SJ, Morley MR, Hazlehurst F. Quantitative measurement of serum and plasma lysozyme: an automated method. Medical laboratory sciences 1990. link 27 Stokes DN. Tumour lysis syndrome and the anaesthesiologist: intensive care aspects of paediatric oncology. Seminars in surgical oncology 1990. link 28 Openshaw S, Craft AW, Charlton M, Birch JM. Investigation of leukaemia clusters by use of a Geographical Analysis Machine. Lancet (London, England) 1988. link90352-2) 29 Lishner M, Pomeranz A, Rozenbaum E, Korzets Z, Shenkman L. Hypercalcaemia-induced acute renal failure as a presenting feature of T-cell leukaemia. European journal of pediatrics 1987. link 30 Gray ES, Balch NJ, Kohler H, Thompson WD, Simpson JG. Congenital leukaemia: an unusual cause of stillbirth. Archives of disease in childhood 1986. link 31 Sato T, Shichishima T, Kimura H, Uchida T, Kariyone S, Ohto H et al.. Immunocytochemical detection of normal and abnormal megakaryocytes using monoclonal antibody to glycoprotein IIb-IIIa (TP80): the quantitative assay in normal and in leukaemic patients. Scandinavian journal of haematology 1986. link 32 Murray JA, Mehrotra PK, Brown MJ, Slater DN. Monocytic sarcoma of the sclera. Acta haematologica 1984. link 33 Ohno Y, Takuma T, Asahi K, Isono K. Differentiation induction of murine erythroleukemia cells by butylated hydroxytoluene. FEBS letters 1984. link80185-4) 34 Broomhall J, May R, Lilleyman JS, Milner RD. Height and lymphoblastic leukaemia. Archives of disease in childhood 1983. link 35 Sridhar KN, Woodhouse CR. Prostatic infiltration in leukaemia and lymphoma. European urology 1983. link 36 Merimsky E, Baratz M, Kahn Y. Leukaemic infiltration of the prostate. British journal of urology 1981. link 37 Nanji AA, Denegri J. Hypokalaemia in leukaemia. Postgraduate medical journal 1981. link 38 Frost T, Isbister JP, Ravich RB. Respiratory failure due to leukostasis in leukaemia. The Medical journal of Australia 1981. link 39 Hinzpeter EN, Knöbel H, Freund J. Spontaneous haemophthalmus in leukaemia. Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde 1978. link 40 Alimena G, Annino L, Dallapiccola B, Ricci N. Ring chromosomes and leukaemia. Experientia 1975. link 41 Guseo A. Electron microscopy of lymphocytic leukaemia cells in the cerebrospinal fluid. Acta neuropathologica. Supplementum 1975. link 42 Lee MB, Neill DW, Bridges JM. Urinary amino acid excretion in subjects with leukaemia. Journal of clinical pathology 1967. link

Erythroleukemia, FAB M6