Erythroleukemia: Difference between revisions

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{{SI}}
{{SI}}
{{CMG}};  {{AE}}{{MA}} [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu]
{{CMG}};  {{AE}}{{MA}} [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu]


{{SK}}Pure erythroid leukemia,  FAB ( French-American-British)  M6, acute erythroid leukemia, Di Guglielmo’s disease  
{{SK}}Pure erythroid leukemia,  FAB ( French-American-British)  M6, acute erythroid leukemia, Di Guglielmo’s disease  
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==Causes==
==Causes==
Erythroleukemia may be caused by translocation t(1;16) generating the fusion gene NFIA/CBFA2T3. <ref name="pmid23032695">{{cite journal |vauthors=Micci F, Thorsen J, Panagopoulos I, Nyquist KB, Zeller B, Tierens A, Heim S |title=High-throughput sequencing identifies an NFIA/CBFA2T3 fusion gene in acute erythroid leukemia with t(1;16)(p31;q24) |journal=Leukemia |volume=27 |issue=4 |pages=980–2 |date=April 2013 |pmid=23032695 |pmc=3626019 |doi=10.1038/leu.2012.266 |url=}}</ref>
Erythroleukemia may be caused by translocation t(1;16) generating the fusion gene NFIA/CBFA2T3. <ref name="pmid23032695">{{cite journal |vauthors=Micci F, Thorsen J, Panagopoulos I, Nyquist KB, Zeller B, Tierens A, Heim S |title=High-throughput sequencing identifies an NFIA/CBFA2T3 fusion gene in acute erythroid leukemia with t(1;16)(p31;q24) |journal=Leukemia |volume=27 |issue=4 |pages=980–2 |date=April 2013 |pmid=23032695 |pmc=3626019 |doi=10.1038/leu.2012.266 |url=}}</ref>
OR
Common causes of [disease] include [cause1], [cause2], and [cause3].
OR
The most common cause of secondary  is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
OR
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].


==Differentiating ((Page name)) from Other Diseases==
==Differentiating ((Page name)) from Other Diseases==
Line 169: Line 157:


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
If left untreated, patients with Erythroleukemia may progress to develop bleeding due to [[disseminated intravascular coagulation]].  
 
OR


Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
Common complications of erythroleukemia include infection and bleeding. Therapy related complications are rash, c''ardiomyopathy and cerebellar toxicity.''
 
OR


Prognosis is generally poor. 3-9 months after initial diagnosis is medican survival range. <ref name="pmid28420120">{{cite journal |vauthors=Almeida AM, Prebet T, Itzykson R, Ramos F, Al-Ali H, Shammo J, Pinto R, Maurillo L, Wetzel J, Musto P, Van De Loosdrecht AA, Costa MJ, Esteves S, Burgstaller S, Stauder R, Autzinger EM, Lang A, Krippl P, Geissler D, Falantes JF, Pedro C, Bargay J, Deben G, Garrido A, Bonanad S, Diez-Campelo M, Thepot S, Ades L, Sperr WR, Valent P, Fenaux P, Sekeres MA, Greil R, Pleyer L |title=Clinical Outcomes of 217 Patients with Acute Erythroleukemia According to Treatment Type and Line: A Retrospective Multinational Study |journal=Int J Mol Sci |volume=18 |issue=4 |pages= |date=April 2017 |pmid=28420120 |pmc=5412421 |doi=10.3390/ijms18040837 |url=}}</ref> A high proerythroblast/myeloblast ratio correlates with worse outcome.<ref name="pmid17852448">{{cite journal |vauthors=Srinivas U, Kumar R, Pati H, Saxena R, Tyagi S |title=Sub classification and clinico-hematological correlation of 40 cases of acute erythroleukemia - can proerythroblast/myeloblast and proerythroblast/total erythroid cell ratios help subclassify? |journal=Hematology |volume=12 |issue=5 |pages=381–5 |date=October 2007 |pmid=17852448 |doi=10.1080/10245330701393816 |url=}}</ref>
Prognosis is generally poor. 3-9 months after initial diagnosis is medican survival range. <ref name="pmid28420120">{{cite journal |vauthors=Almeida AM, Prebet T, Itzykson R, Ramos F, Al-Ali H, Shammo J, Pinto R, Maurillo L, Wetzel J, Musto P, Van De Loosdrecht AA, Costa MJ, Esteves S, Burgstaller S, Stauder R, Autzinger EM, Lang A, Krippl P, Geissler D, Falantes JF, Pedro C, Bargay J, Deben G, Garrido A, Bonanad S, Diez-Campelo M, Thepot S, Ades L, Sperr WR, Valent P, Fenaux P, Sekeres MA, Greil R, Pleyer L |title=Clinical Outcomes of 217 Patients with Acute Erythroleukemia According to Treatment Type and Line: A Retrospective Multinational Study |journal=Int J Mol Sci |volume=18 |issue=4 |pages= |date=April 2017 |pmid=28420120 |pmc=5412421 |doi=10.3390/ijms18040837 |url=}}</ref> A high proerythroblast/myeloblast ratio correlates with worse outcome.<ref name="pmid17852448">{{cite journal |vauthors=Srinivas U, Kumar R, Pati H, Saxena R, Tyagi S |title=Sub classification and clinico-hematological correlation of 40 cases of acute erythroleukemia - can proerythroblast/myeloblast and proerythroblast/total erythroid cell ratios help subclassify? |journal=Hematology |volume=12 |issue=5 |pages=381–5 |date=October 2007 |pmid=17852448 |doi=10.1080/10245330701393816 |url=}}</ref>

Revision as of 03:26, 28 November 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2] [3] [4] [5] [6] [7]

Synonyms and keywords:Pure erythroid leukemia, FAB ( French-American-British) M6, acute erythroid leukemia, Di Guglielmo’s disease

Overview

Historical Perspective

Erythroleukemia was first discovered by M. Copelli, in 1912.[1]

In 1917, Di Guglielmo, Italian hematologist, described leukemic nature of the erythroleukemia.

The association between [important risk factor/cause] and [disease name] was made in/during [year/event].

In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].

In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].

There have been several outbreaks of [disease name], including -----.

In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].

The first known case of acute erythroid leukemia was described in 1912 by M. Copelli under the name erythromatosis. In 1917, Italian hematologist Giovanni Di Guglielmo (1886–1962), expanded on the description, coining the name "eritroleucemia" (Italian for erythroleukemia). Di Guglielmo was the first to recognize the leukemic nature of the condition, and it is sometimes referred to as Di Guglielmo's syndrome in recognition of his work.

Chris Squire, bassist from the progressive rock group Yes, died from complications related to acute erythroid leukemia on June 27, 2015

ure erythroid leukemia (FAB M6) — Pure erythroid leukemia (equivalent to FAB M6, acute erythroid leukemia, erythroleukemia, or Di Guglielmo’s disease) accounts for <5 percent of AML. The erythroblasts do not express markers of myeloid lineage and do not stain with MPO [22]. They may express CD117 and do react with antibodies to hemoglobin A and glycophorin. In prior versions of the WHO classification system, two types of this leukemia were recognized, the erythroid/myeloid type and the "pure" type [39], and a diagnosis of AML, erythroid/myeloidcould be made if erythroid precursors accounted for more than 50 percent of the cells in the bone marrow and the blasts accounted for 20 percent or more of the non-erythroid cells. In the 2016 revision of the WHO classification, a diagnosis of acute leukemia requires blasts to account for 20 percent or more of the bone marrow cellularity irrespective of the number of erythroid precursors. Entities with less than 20 percent blasts have been reclassified as other forms of AML or MDS [3].

A diagnosis of pure erythroid leukemia is made in patients without exposure to cytotoxic agents and without AML-associated recurrent genetic abnormalities in whom erythroblasts account for >80 percent of the marrow cells. The erythroblasts are primarily at the pronormoblast stage and may have vacuolization in the cytoplasm surrounding the nucleus. This has been referred to as a "pearl necklace," and should not be confused with the vacuolated cells seen in Burkitt leukemia/lymphoma.

The "erythroid/myeloid type" was previously defined as those with erythroid precursors accounting for >50 percent of the nucleated marrow elements and myeloblasts accounting for >20 percent of the nonerythroid forms (picture 14). Evaluation of myeloblasts in such cases now considers the percentage of total nucleated cells and does not limit the percentage to nonerythroid forms. These cases are classified as MDS or as a non-erythroid subtype of AML, not otherwise specified depending upon the percentage of myeloblasts, identification of cytogenetic abnormalities, and the presence of dysplasia.

Classification

Erythroleukemia accounts for <5 percent of AML( acute myeloid leukemia). Erythroleukemia may be classified according to previous version WHO into 2 subtypes : The erythroid/myeloid type and the pure type.

Diagnosis of erythroid/myeloid type, base on previous version WHO:

  • Erythroid precursors more than 50 percent of the cells in bone marrow and,
  • The blasts compromise 20 percent or more of the non-erythroid cells

2016 version of WHO calcification for AML (erythroid/myeloid type) :

  • 20 percent or more blasts in bone marrow irrespective of the number of erythroid precursors

Diagnosis of pure erythroid leukemia:

  • Erythroblasts ( at the stage of pronormoblast >80 percent of the marrow cells in patients without exposure to cytotoxic agent and without AML genetic abnormalities. Erythroblasts may have vacuolization in the cytoplasm arrounding the nucleus ( pearl necklace).

OR

Erythroleukemia may be classified into 2 groups. De novo cases of erythroleukemia and secondary Erythroleukemia. De novo cases are not associated with any risk factors. The most common predisposing factors in secondary acute erythroleukemia are as follows:based on [classification method 1], [classification method 2], and [classification method 3]. [Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].

OR

Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.

OR

If the staging system involves specific and characteristic findings and features: According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].

OR

The staging of [malignancy name] is based on the [staging system].

OR

There is no established system for the staging of [malignancy name].

Pathophysiology

Erythroleukemia is a neoplastic proliferation of myeloid and erythroid precursors of bone marrow hematopoietic stem cells. Erythroleukemia is accounting for 3–5% of all AML cases.[2] A pure erythroid proliferation on rare occasion may occur. The erythroblasts do not stain with MPO ( myeloperoxidase). Markers of myeloid lineage can not be expressed on the erythroblasts.

Gross pathology:

Microscopic examanination:

Erythroblasts may have vacuolization in the cytoplasm arrounding the nucleus ( pearl necklace).

Immunohistochemistry

and should not be confused with the vacuolated cells seen in Burkitt leukemia/lymphoma.

The "erythroid/myeloid type" was previously defined as those with erythroid precursors accounting for >50 percent of the nucleated marrow elements and myeloblasts accounting for >20 percent of the nonerythroid forms (picture 14). Evaluation of myeloblasts in such cases now considers the percentage of total nucleated cells and does not limit the percentage to nonerythroid forms. These cases are classified as MDS or as a non-erythroid subtype of AML, not otherwise specified depending upon the percentage of myeloblasts, identification of cytogenetic abnormalities, and the presence of dysplasia.

The exact pathogenesis of [disease name] is not fully understood.

OR

It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].

OR

[Pathogen name] is usually transmitted via the [transmission route] route to the human host.

OR

Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.

OR


[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].

OR

The progression to [disease name] usually involves the [molecular pathway].

OR

The pathophysiology of [disease/malignancy] depends on the histological subtype.

Causes

Erythroleukemia may be caused by translocation t(1;16) generating the fusion gene NFIA/CBFA2T3. [3]

Differentiating ((Page name)) from Other Diseases

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Epidemiology and Demographics

The incidence of erythroleukemia is approximately 0.077 per 100,000 individuals worldwide. [4]

Erythroleukemia commonly affects individuals older than 50 years of age with a median age of 65. [5]

There is no racial predilection to Erythroleukemia.

Men are slightlly more affected by Erythroleukemia than women.


Risk Factors

There are no established risk factors for de novo cases of erythroleukemia.

The most potent risk factor in the development of secondary Erythroleukemia is previous MDS ( myelodysplastic syndrome). [6]

Other risk factors include:

  • Ionizing radiation such as Thorium dioxide suspension (Thorotrast)
  • Previous use of chemotherapy drugs such as alkylating agents
  • Famillial erythroleukemia, autosomal dominant disorder

Screening

There is insufficient evidence to recommend routine screening for Erythroleukemia.

Natural History, Complications, and Prognosis

If left untreated, patients with Erythroleukemia may progress to develop bleeding due to disseminated intravascular coagulation.

Common complications of erythroleukemia include infection and bleeding. Therapy related complications are rash, cardiomyopathy and cerebellar toxicity.

Prognosis is generally poor. 3-9 months after initial diagnosis is medican survival range. [7] A high proerythroblast/myeloblast ratio correlates with worse outcome.[8]

Diagnosis

Diagnostic Study of Choice

Bone marrow biopsy

The diagnosis of Erythroleukemia is based on 2016 version of WHO classification for AML:

  • AML (erythroid/myeloid type): 20 percent or more blasts in bone marrow irrespective of the number of erythroid precursors
  • Pure erythroid leukemia: Erythroblasts, at the stage of pronormoblast, more than 80 percent of the marrow cells in patients without exposure to cytotoxic agent and without AML genetic abnormalities. Erythroblasts may have vacuolization in the cytoplasm arrounding the nucleus ( pearl necklace).

History and Symptoms

  • Fatigue
  • Malaise
  • Fatigue
  • Malaise
  • Bone pain
  • Abdominal pain
  • Weight loss
  • Easy bruising
  • Fever
  • Dyspnea

Less common symptoms of Erythroleukemia include diffuse joint pain

Physical Examination

Patients with Erythroleukemia usually appear anemic. Physical examination of patients with Erythroleukemia may include:[9]

  • Ecchymoses or petechiae
  • Hepatomegaly
  • Splenomegaly
  • Lymphadenopathy
  • Headache

Laboratory Findings

  • Pancytopenia[10]
  • Few peripheral blood blasts[11]
  • Dysplasia in bone marrow and peripheral blood
  • Dysplastic PAS positive erythroblasts with overexpression of the multidrug resistance (MDR) gene product P-glycoprotein
  • High freqiency of mutations, especially of TP53[12]

Electrocardiogram

Electrocardiogram is useful for assessment of QT interval prior to starting chemptherapy. It is also useful for assessing arrhythmias induced by anthracycline chemotherapy. [13]For more information, click here.

X-ray

An x-ray may be helpful in the diagnosis of complications of Erythroleukemia management which include infection, volume overload. Chest x-ray is also useful for venous catheter placement for chemotherapy.

Echocardiography or Ultrasound

An echocardiogram is helpful for assessing cardiac function ( ejection fraction) in patients with acute myeloid leukemia before and after receiving anthracycline chemotherapy. [14]

An ultrasound is useful for diagnosis of lower extremity thrombosis, which commonly occurs in patients with acute myeloid leukemia.[15]

CT scan

Abdominal and chest CT scan may be helpful in the diagnosis of acute myeloid leukemia. Findings on CT scan suggestive of of acute myeloid leukemia include lymphadenopathy, hepatomegaly, splenomegaly and pulmonary embolism because of deep venous thrombosis. [16]

Non contrast brain CT scan is useful to rule out CNS bleed.[17]

MRI

Brain MRI is helpful in the diagnosis of CNS bleeding in acute myeloid leukemia. [18]

Other Imaging Findings

There are no other imaging findings associated with Erythroleukemia.

Other Diagnostic Studies

Flow cytometry:

The myeloid blasts are often postive for myeloid marker such as CD117, CD13, CD33 and MPO.[19]

The erythroblasts lack myeloid antigens. They are postive for glycophorin A.

Cytogenetics:

Loss of all or part of the long arm (q) of chromosomes 5 and/or 7. [20]

Treatment

Medical Therapy

Pharmacologic medical therapy is recommended among patients with Erythroleukemia who are not candidate for intensive chemotherapy or allogenic hematopoietic stem cell transplantation. [21]

Pharmacologic medical therapies for Erythroleukemia include hyypomethylating agents ( HMA) such as:[22]

  • Azacitidine
  • Decitabine

For more information about acute myeloid leukemia medical therapy, click here.

Surgery

  • Allo-SCT ( Allogenic hematopoietic stem cell transplantation)[21]

.

Primary Prevention

There are no established measures for the primary prevention of Erythroleukemia.

Secondary Prevention

Effective measures for the secondary prevention of Erythroleukemia include maintenance of remission treatment posttransplant.[23]

References

  1. Santos FP, Bueso-Ramos CE, Ravandi F (December 2010). "Acute erythroleukemia: diagnosis and management". Expert Rev Hematol. 3 (6): 705–18. doi:10.1586/ehm.10.62. PMID 21091147.
  2. Santos FP, Bueso-Ramos CE, Ravandi F (December 2010). "Acute erythroleukemia: diagnosis and management". Expert Rev Hematol. 3 (6): 705–18. doi:10.1586/ehm.10.62. PMID 21091147.
  3. Micci F, Thorsen J, Panagopoulos I, Nyquist KB, Zeller B, Tierens A, Heim S (April 2013). "High-throughput sequencing identifies an NFIA/CBFA2T3 fusion gene in acute erythroid leukemia with t(1;16)(p31;q24)". Leukemia. 27 (4): 980–2. doi:10.1038/leu.2012.266. PMC 3626019. PMID 23032695.
  4. Wells AW, Bown N, Reid MM, Hamilton PJ, Jackson GH, Taylor PR (August 2001). "Erythroleukaemia in the north of England: a population based study". J. Clin. Pathol. 54 (8): 608–12. PMC 1731487. PMID 11477115.
  5. Santos FP, Bueso-Ramos CE, Ravandi F (December 2010). "Acute erythroleukemia: diagnosis and management". Expert Rev Hematol. 3 (6): 705–18. doi:10.1586/ehm.10.62. PMID 21091147.
  6. Atkinson J, Hrisinko MA, Weil SC (December 1992). "Erythroleukemia: a review of 15 cases meeting 1985 FAB criteria and survey of the literature". Blood Rev. 6 (4): 204–14. PMID 1486289.
  7. Almeida AM, Prebet T, Itzykson R, Ramos F, Al-Ali H, Shammo J, Pinto R, Maurillo L, Wetzel J, Musto P, Van De Loosdrecht AA, Costa MJ, Esteves S, Burgstaller S, Stauder R, Autzinger EM, Lang A, Krippl P, Geissler D, Falantes JF, Pedro C, Bargay J, Deben G, Garrido A, Bonanad S, Diez-Campelo M, Thepot S, Ades L, Sperr WR, Valent P, Fenaux P, Sekeres MA, Greil R, Pleyer L (April 2017). "Clinical Outcomes of 217 Patients with Acute Erythroleukemia According to Treatment Type and Line: A Retrospective Multinational Study". Int J Mol Sci. 18 (4). doi:10.3390/ijms18040837. PMC 5412421. PMID 28420120.
  8. Srinivas U, Kumar R, Pati H, Saxena R, Tyagi S (October 2007). "Sub classification and clinico-hematological correlation of 40 cases of acute erythroleukemia - can proerythroblast/myeloblast and proerythroblast/total erythroid cell ratios help subclassify?". Hematology. 12 (5): 381–5. doi:10.1080/10245330701393816. PMID 17852448.
  9. Zuo Z, Polski JM, Kasyan A, Medeiros LJ (September 2010). "Acute erythroid leukemia". Arch. Pathol. Lab. Med. 134 (9): 1261–70. doi:10.1043/2009-0350-RA.1. PMID 20807044.
  10. Peng J, Hasserjian RP, Tang G, Patel KP, Goswami M, Jabbour EJ, Garcia-Manero G, Medeiros LJ, Wang SA (2016). "Myelodysplastic syndromes following therapy with hypomethylating agents (HMAs): development of acute erythroleukemia may not influence assessment of treatment response". Leuk. Lymphoma. 57 (4): 812–9. doi:10.3109/10428194.2015.1079318. PMID 26293512.
  11. Lessard M, Struski S, Leymarie V, Flandrin G, Lafage-Pochitaloff M, Mozziconacci MJ, Talmant P, Bastard C, Charrin C, Baranger L, Hélias C, Cornillet-Lefebvre P, Mugneret F, Cabrol C, Pagès MP, Fert-Ferret D, Nguyen-Khac F, Quilichini B, Barin C, Berger R (December 2005). "Cytogenetic study of 75 erythroleukemias". Cancer Genet. Cytogenet. 163 (2): 113–22. doi:10.1016/j.cancergencyto.2005.05.006. PMID 16337853.
  12. Grossmann V, Bacher U, Haferlach C, Schnittger S, Pötzinger F, Weissmann S, Roller A, Eder C, Fasan A, Zenger M, Staller M, Kern W, Kohlmann A, Haferlach T (September 2013). "Acute erythroid leukemia (AEL) can be separated into distinct prognostic subsets based on cytogenetic and molecular genetic characteristics". Leukemia. 27 (9): 1940–3. doi:10.1038/leu.2013.144. PMID 23648669.
  13. Hefti E, Blanco JG (2016). "Anthracycline-Related Cardiotoxicity in Patients with Acute Myeloid Leukemia and Down Syndrome: A Literature Review". Cardiovasc Toxicol. 16 (1): 5–13. doi:10.1007/s12012-015-9307-1. PMC 4514565. PMID 25616318.
  14. Armenian SH, Gelehrter SK, Vase T, Venkatramani R, Landier W, Wilson KD, Herrera C, Reichman L, Menteer JD, Mascarenhas L, Freyer DR, Venkataraman K, Bhatia S (December 2014). "Screening for cardiac dysfunction in anthracycline-exposed childhood cancer survivors". Clin. Cancer Res. 20 (24): 6314–23. doi:10.1158/1078-0432.CCR-13-3490. PMC 4268342. PMID 24947931.
  15. Oehadian A, Iqbal M, Sumantri R (October 2009). "Deep vein thrombosis in acute myelogenous leukemia". Acta Med Indones. 41 (4): 200–4. PMID 20124617.
  16. Vallipuram J, Dhalla S, Bell CM, Dresser L, Han H, Husain S, Minden MD, Paul NS, So M, Steinberg M, Vallipuram M, Wong G, Morris AM (April 2017). "Chest CT scans are frequently abnormal in asymptomatic patients with newly diagnosed acute myeloid leukemia". Leuk. Lymphoma. 58 (4): 834–841. doi:10.1080/10428194.2016.1213825. PMID 27642861.
  17. Chen CY, Tai CH, Cheng A, Wu HC, Tsay W, Liu JH, Chen PY, Huang SY, Yao M, Tang JL, Tien HF (August 2012). "Intracranial hemorrhage in adult patients with hematological malignancies". BMC Med. 10: 97. doi:10.1186/1741-7015-10-97. PMC 3482556. PMID 22931433.
  18. Cervantes GM, Cayci Z (May 2015). "Intracranial CNS Manifestations of Myeloid Sarcoma in Patients with Acute Myeloid Leukemia: Review of the Literature and Three Case Reports from the Author's Institution". J Clin Med. 4 (5): 1102–12. doi:10.3390/jcm4051102. PMC 4470219. PMID 26239467.
  19. Sharma A, Buxi G, Walia R, Yadav RB, Sharma S (2011). "Childhood acute erythroleukemia diagnosis by flow cytometry". Indian J Pathol Microbiol. 54 (1): 173–5. doi:10.4103/0377-4929.77395. PMID 21393910.
  20. Atkinson J, Hrisinko MA, Weil SC (December 1992). "Erythroleukemia: a review of 15 cases meeting 1985 FAB criteria and survey of the literature". Blood Rev. 6 (4): 204–14. PMID 1486289.
  21. 21.0 21.1 Almeida AM, Prebet T, Itzykson R, Ramos F, Al-Ali H, Shammo J, Pinto R, Maurillo L, Wetzel J, Musto P, Van De Loosdrecht AA, Costa MJ, Esteves S, Burgstaller S, Stauder R, Autzinger EM, Lang A, Krippl P, Geissler D, Falantes JF, Pedro C, Bargay J, Deben G, Garrido A, Bonanad S, Diez-Campelo M, Thepot S, Ades L, Sperr WR, Valent P, Fenaux P, Sekeres MA, Greil R, Pleyer L (April 2017). "Clinical Outcomes of 217 Patients with Acute Erythroleukemia According to Treatment Type and Line: A Retrospective Multinational Study". Int J Mol Sci. 18 (4). doi:10.3390/ijms18040837. PMC 5412421. PMID 28420120.
  22. Fenaux P, Mufti GJ, Hellström-Lindberg E, Santini V, Gattermann N, Germing U, Sanz G, List AF, Gore S, Seymour JF, Dombret H, Backstrom J, Zimmerman L, McKenzie D, Beach CL, Silverman LR (February 2010). "Azacitidine prolongs overall survival compared with conventional care regimens in elderly patients with low bone marrow blast count acute myeloid leukemia". J. Clin. Oncol. 28 (4): 562–9. doi:10.1200/JCO.2009.23.8329. PMID 20026804.
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