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PubMed1985

Acute nonlymphocytic leukemia, preleukemia, and solid tumors following intensive chemotherapy of small cell carcinoma of the lung.

Six of 796 patients treated with intensive combination chemotherapy for small cell carcinoma of the lung developed overt acute nonlymphocytic leukemia (ANLL) (three patients) or preleukemia with severe refractory cytopenia and clonal cytogenetic abnormalities in bone marrow cells (three patients). The latent period to development of preleukemia or leukemia was less than two years in four of the six patients. The cumulative risk of preleukemia and leukemia according to a Kaplan-Meier estimate was 14.0% +/- 6.9% (mean +/- SE) four years after the start of treatment. The relative risk of overt ANLL was 77, since three cases were observed v 0.039 cases expected, based on the age- and sex-specific incidence of acute nonlymphocytic leukemia in the general Danish population. The risk of secondary solid tumors was not increased. The possible causes of the exceptionally early appearance and very high cumulative risk of leukemic complications found in the present study, as compared to previous experience in other malignant diseases, is discussed, including the implications for future therapy of patients with small cell lung cancer.

Acute Disease↗
PubMed1977

Preleukemia. Cytogenetic clues in some confusing disorders.

A number of disease states are considered "preleukemic" because they carry a significantly increased risk for the subsequent development of frank leukemia. These include a variety of cytopenias, myeloproliferative disorders, and childhood syndromes. Cytogenetic data suggest that these preleukemic disorders may not be qualitatively different from leukemia but simply represent quantitative differences in the degree of selective growth advantage enjoyed by a proliferating abnormal hemic population. Recent chromosome studies have indicated that a) this proliferation is characteristically clonal in both preleukemia and leukemia, apparently resulting from a heritable change in a marrow stem cell that allows it to escape to some degree from normal growth regulation; b) genetic instability in the clone, with additional genetic change, may often underlie clinical progression from the relative indolence of preleukemia or chronic leukemia to an aggressive stage comparable to acute leukemia; and c) certain specific chromosome segments carry genes important in the acquisition of growth advantage by hematopoietic stem cells, and many of these are common to both preleukemia and leukemia. Expansion of hemic clones may also be influenced significantly by alterations in the growth control mechanisms themselves. For instance, in various preleukemic states, preexisting marrow hypoplasia may permit clones with only minimal selective advantage to reach demonstrable size. Chromosome findings may help to establish the diagnosis and prognosis in preleukemic disorders, but additional long-term data are needed.

Cell Transformation, Neoplastic↗
PubMed1983

Restoration of normal hematopoiesis by bone marrow ablation and allogeneic marrow transplantation in a case of Hodgkin's disease therapy-related preleukemia.

Therapy-related leukemias are generally preceded by a preleukemic phase of several months duration, characterized by pancytopenia, abnormal bone marrow findings, and nonrandom chromosomal abnormalities in almost all cases. No specific therapeutic guidelines are recommended in this preleukemic phase or any other type of preleukemia; aggressive combination chemotherapy is usually withheld until the full expression of leukemia. A 22-yr-old man with therapy-related preleukemia following treatment of Hodgkin's disease received as primary treatment ablative chemotherapy followed by marrow transplantation from his histocompatible sister. At day 316, the patient is still in complete bone marrow recovery with a normal donor karyotype. In the light of the very poor results obtained with conventional chemotherapy regimens once the leukemic phase is established, we suggest that bone marrow transplantation, if undertaken before leukemic conversion, may be the treatment of choice in young adults with therapy-related preleukemia.

Adult↗
PubMed1983

[Preleukemia].

Case reports dealing with preleukemic syndromes are rare. During the last years preleukemia has been ill defined. Nowadays, most authors agree that a marrow stem disorder with clinically recognisable haematological abnormalities, which proceed the development of overt leukemia, is to be regarded as preleukemia syndrome. Clinical and haematological features are different in preleukemic syndromes terminating with acute lymphoblastic (ALL) and acute non-lymphoblastic leukemia (ANLL). We describe two cases of preleukemia--the first evolving into ALL and the second into ANLL. Our first patient had developed pancytopenia and hypocellular bone marrow five months before overt ALL. In the moment the diagnosis was made clinical examination revealed enlarged lymph glands, liver and spleen. Laboratory tests showed pancytopenia and bone marrow infiltrated with blasts L1 morphology (F. A. B. classification). Preleukemic phase terminating with ANLL featured pancytopenia and hypercellular bone marrow infiltrated with histiocytes, some showing signs of erythrocyte-, leukocyte- and platelet-ingestion. Diagnosis of acute monoblastic leukemia M5 (F. A. B.) was made three months after the illness onset, according to bone marrow infiltration with monoblasts. Clinical and haematological features helpful in the recognition of preleukemic syndromes are discussed.

Bone Marrow↗
PubMed1982

[The bone marrow karyotype in refractory anemia and preleukemia].

The term preleukemia may be used to refer to patients with acquired chronic cytopenias (refractory anemia with an excess of blast cells, refractory sideroblastic idiopathic anemia, or others idiopathic refractory cytopenias) who develop acute myeloid leukemia (AML) months or years later. In these syndromes, an abnormal bone marrow karyotype is found in about 50% cases, like in de novo AML. These abnormalities are similar to those observed in AML (mostly +8, -7, -5 or 5q-). The translocations t(8;21) and t(15;17) are never observed in preleukemia. Correlations exist between hematological data and cytogenetic features namely, in the 5q- syndrome. Thus in preleukemia the cytogenetic analysis is a valuable diagnostic method. At the present time, the prognostic value of the bone marrow karyotype is not clearly established but in single chromosome deletions (5q-, 20q-) the acute transformation is rare or delayed. At the opposite, evolution of the karyotype is generally regarded as a progression to high malignancy.

Anemia, Aplastic↗
PubMed1982

Platelet aggregation and electron microscopic studies of platelets in preleukemia.

Platelet aggregation and electron microscopic studies of platelets were carried out at the time of diagnosis in 11 patients thought to have preleukemia. The clinical course confirmed the diagnosis of preleukemia in seven, of whom platelet aggregation had been performed in six and the results were abnormal in all. Electron microscopic studies were performed in six of the seven, and showed abnormal morphologic structure in five. One patient was unavailable for follow-up, and aplastic anemia developed in another. In time, two patients were seen to have nonmalignant blood disorders. Results of platelet aggregation studies were normal in both of these, but electron microscopy showed morphologic abnormalities. Platelet aggregation is useful in confirming the diagnosis of preleukemia. Electron microscopy of platelets is not so clearly helpful.

Blood Platelets↗
PubMed1976

Proliferation and production of hemopoietic cells two stages of disease: preleukemia and overt leukemia.

The kinetics of erythropietic and granulocytopoietic cell proliferation have been investigated in the same patient at two distinct stages: firstly in preleukemia presenting as pancytopenia with ineffective erythropoiesis, and secondly 2 years later in acute myelogenous leukemia. The method investigation is based on determining the DNA synthesis rate of individual cells by means of quantitative 14C-autoradiography after short-term incubation with 14C-thymidine and fluorodeoxyuridine. Erythropoiesis was equally ineffective in the two stages, the rate of proliferation, however, slowed down towards the leukemic state. The production rate of myeloblasts was markedly reduced in preleukemia accompained by a very low labelling index. In leukemia on the other hand the production rate was increased to such a degree that the leukemic myeoblast compartment is to be considered as prevailingly self-reproductive. The proliferation rate of myeloblasts was reduced already in preleukemia, and there was a further decrease in leukemia. From the point of view of cell kinetics the manifestation of leukemia in this patient is explained best by a change in the mode of proliferation: the myeloblasts change from steady state growth to behaving like an exponentially expanding population.

Aged↗
PubMed1975

Preleukemia: hematological disorders prior to onset of leukemia.

Published data on Japanese leukemia patients with a preleukemic hematological disorder were assessed. The reexamined cases were from the "Japona Centra Revuo Medicina" reported during the period from 1952 to 1971. Among preleukemic hematological disorders, hypoplastic anemia was the most frequently reported (41 of 62 cases). These "hypoplastic preleukemia" patients were rather elderly and terminated mostly in atypical myelocytic leukemia. The chief hematological feature of the hypoplastic preleukemia cases was the coexistence of a relative erythroid hyperplasia and a slight increase of myeloblasts in the bone marrow that was unusual in hypoplastic anemia. The presence of pancytopenia and hypocellular marrow with a relative erythroid hyperplasia combined with a slight increase of myeloblasts probably indicates hypoplastic preleukemia that terminates later in acute leukemia.

Acute Disease↗
PubMed1983

Deficiency in Epstein-Barr virus receptors on B-lymphocytes of preleukemia patients.

Lymphocytes from eight preleukemia patients were exposed to Epstein-Barr virus (EBV) in vitro in an attempt to establish lymphoblastoid cell lines. No signs of viral infection were detected, and no cell lines were obtained. Studies using fluorescein-labeled EBV and flow cytometry revealed an unusual and consistent deficiency in EBV receptors in all patients examined. In control studies, about 15% of the unseparated lymphocytes from healthy donors bound fluorescein-labeled EBV. In spite of the lack of EBV receptors, B-lymphocytes amounted to 10 to 20% of the preleukemia lymphocyte populations, a proportion similar to that in healthy donors. When lymphocytes from preleukemic patients were first implanted with functional EBV receptors and then exposed to EBV, synthesis of EBV-determined nuclear, early, and viral capsid antigens was induced. Subsequently, several cell lines originating from preleukemic patients' lymphocytes were established. These lines are of a B-lymphocyte origin and carry EBV genome. They will provide experimental material for the molecular analysis of lymphocytic defects in preleukemia and their possible role in the transition to acute leukemia.

B-Lymphocytes↗
PubMed1984

Granulocytic sarcoma. A new finding in the setting of preleukemia.

Preleukemia is a well-defined syndrome of hematopoietic dysfunction that may antedate the development of acute myelogenous leukemia. Granulocytic sarcoma refers to neoplastic infiltration in the skin, composed of immature cells of the granulocyte series. We report two cases of granulocytic sarcoma in the setting of preleukemia. The clinical importance of these cases, as well as the cutaneous manifestations of leukemia and the clinical spectrum of granulocytic sarcoma, are presented.

Aged↗
PubMed1990

High risk of therapy-related leukemia and preleukemia after therapy with prednimustine, methotrexate, 5-fluorouracil, mitoxantrone, and tamoxifen for advanced breast cancer.

Therapy-related acute non-lymphocytic leukemia or preleukemia was observed in five of 71 patients with advanced breast cancer treated with combination chemotherapy comprising prednimustine, methotrexate, 5-fluorouracil, mitoxantrone, and tamoxifen. In this closely followed cohort of patients the cumulative risk of leukemic complications was 25.4% +/- 10.3% (+/- SE) 37 months after start of chemotherapy. The relative risk of overt leukemia was 339 (95% CI: 41-1223), as two cases were observed versus 0.0059 cases expected. The very high risk of leukemia and preleukemia observed may partly reflect the advanced age of the patients (mean, 61 years) and partly the diagnostic procedures used, which included cytogenetic screening of all patients developing refractory cytopenia. A particularly high leukemogenic effect of prednimustine or a synergism between prednimustine and other drugs used in this study cannot be excluded. In the light of the above results, the authors caution against the use of intensive combination chemotherapy with alkylating agents as in the current study in potentially curable patients with breast cancer.

Adult↗
PubMed2000

Characterization of a highly complex region in Xq13 and mapping of three isodicentric breakpoints associated with preleukemia.

The chromosomal abnormality represented by an isodicentric X chromosome [idic(X)(q13)] is associated with a subset of acute myeloid leukemia (AML) and preleukemia observed in elderly females. A previous study localized the breakpoints of two acquired isodicentric X chromosomes associated with myelodysplasia to a 450-kb region proximal to the XIST gene. Here we report the construction and extensive characterization of a reliable 1-Mb P1 artificial chromosome and bacterial artificial chromosome contig covering a highly problematic region in Xq13 that includes the previously described isodicentric breakpoint region. In addition to mapping of the brain-specific gene (NAP1L2) and the phosphoglyceryl kinase alpha subunit 1 gene (PHKA1) and generation and mapping of a large number of STSs throughout the contig, we have mapped a putative transcriptional regulatory protein (HDACL1), and 35 ESTs. Sequencing data, Southern blot analysis, and fiber-FISH analysis have permitted characterization of extensive region-specific duplications and triplications in addition to an unusually high concentration of long interspersed repeat elements, both of which could be implicated in isodicentric chromosome formation and other Xq13 chromosome aberrations. FISH analysis of metaphase chromosomes from two previously unpublished AML patients and one preleukemic patient using cosmid clones and selected subclones allowed mapping of the idic(X)(q13) breakpoints to a 100-kb interval, consistent with the involvement of an X-linked gene in the genesis of this form of preleukemia, disruption of which may represent a preliminary step in progression to AML. Assembly and physical mapping of this complex 1-Mb contig establish a foundation for ongoing sequencing and gene identification projects in the region.

Acute Disease↗
PubMed1983

Lymphocyte abnormalities in preleukemia--I. Decreased NK activity, anomalous immunoregulatory cell subsets and deficient EBV receptors.

The development of acute non-lymphocytic leukemia is preceded by a set of symptoms described as the preleukemia syndrome. Six patients who fulfilled the criteria for this preleukemia syndrome have been evaluated for abnormalities in the lymphocyte population. The NK cell activity was reduced, the immunoregulatory cell populations were numerically abnormal, and the B cell subpopulation was deficient in EBV receptors. Thus, in addition to the abnormalities in the myeloid populations, there are serious defects in the lymphoid systems of preleukemic patients.

Adult↗
PubMed1983

Cytogenetics of childhood preleukemia.

Chromosome studies were done on ten children with childhood preleukemia characterized by anemia, thrombocytopenia, blasts in the circulation, and hypercellular marrow with excess blasts. The syndrome was clinically similar to adult preleukemia (myelodysplastic disorder). A chromosomally abnormal clone was found in the marrow in five patients: three with monosomy 7; one with a chromosome No. 21 replaced by two isochromosomes for 21q; and one with multiple alterations including an extra, abnormal chromosome No. 7. It was not apparent that a karyotypic change indicated a worse prognosis. The observed chromosome abnormalities appeared to overlap less with those in acute nonlymphocytic leukemia occurring de novo than is the case in adults, perhaps reflecting differing contributions of genetic and environmental factors to the pathogenesis of the disease at different ages.

Acute Disease↗
PubMed1990

Structural alterations at the putative retinoblastoma locus in some human leukemias and preleukemia.

Homozygous loss of alleles of the retinoblastoma susceptibility locus (RB1) has been implicated in the onset of many different solid tumors. Heterozygous deletions of chromosome 13q14, the region containing the RB1 locus, have been observed by us in several subvariants of leukemia and preleukemia. We examined four cases of leukemia and one case of preleukemia for homozygous inactivation of the RB1 locus; in at least one case, evidence supports the concept that homozygous loss of both alleles of RB1 was an important step during leukemogenesis.

Adolescent↗
PubMed1991

Leukemia and preleukemia in Fanconi anemia patients. A review of the literature and report of the International Fanconi Anemia Registry.

Fanconi anemia (FA) is an autosomal recessive disorder characterized clinically by a progressive pancytopenia, diverse congenital abnormalities, and increased predisposition to malignancy. Although a variable phenotype makes accurate diagnosis on the basis of clinical manifestations difficult in some patients, the unique sensitivity of FA cells to the clastogenic effect of DNA cross-linking agents such as diepoxybutane (DEB) can be used to facilitate the diagnosis. We review all cases of FA reported to have leukemia, preleukemia, or a bone marrow (BM) clonal chromosomal abnormality and include for the first time an analysis of these conditions observed in patients in the International Fanconi Anemia Registry (IFAR). The incidence of acute myelogenous leukemia (AML) in FA patients is more than 15,000 times that observed in children in the general population. Cytogenetic studies of FA-associated leukemias disclose a high frequency of monosomy 7 and duplications involving 1q. There were no occurrences of t(8;21), t(15;17), or abnormalities of 11q, which are associated with M2, M3, and M5 leukemias, respectively, but not with preleukemia. Development of leukemia in FA patients was associated with an exceedingly poor prognosis, with a mean age of death of 15 years. We suggest that all FA patients may be considered preleukemic and that this disorder presents a model for study of the etiology of AML.

Acute Disease↗
PubMed1981

Preleukemia in children.

Six children who developed acute myelomonocytic leukemia presented with a preleukemic syndrome. The incidence of preleukemic presentation of AMML was 17% of children with acute nonlymphocytic leukemia, or 2.9% of all children with acute leukemia at this institution, incidences similar to those in adults. During the preleukemic phase, which lasted from three to 35 months, all children had anemia, all had infectious complications, and three of six had hemorrhagic tendencies. Three received steroids before the diagnosis of AMML, and all had some objective response. Two patients died before receiving therapy for AMML. Four children who received AMML therapy with combinations including cytosine arabinoside and an anthracycline achieved complete remission. Ultimately, all patients died. Clues to diagnosis of preleukemia include unexplained cytopenias, either absolute or functional, peripheral blasts, progressive megaloblastosis with an elevated B12 value, dyserythropoiesis, abnormalities of nuclear segmentation, nonrandom chromosomal alterations, and reduced marrow colony to cluster ratio in vitro. Until there is a highly effective therapy for ANLL, precisely when to treat the child with preleukemia remains uncertain. However, treatment should be started before infectious complications or hemorrhagic tendencies become life-threatening.

Adolescent↗
PubMed1984

Allogeneic marrow transplantation in the treatment of preleukemia.

Ten patients with preleukemia and life-threatening pancytopenia were treated with marrow transplantation. In all ten cases allogeneic marrow was successfully engrafted. In three patients prepared for transplantation with cyclophosphamide alone, the abnormal cell clone either persisted or reemerged within 6 months of transplantation. The other seven patients were treated with cyclophosphamide plus total body irradiation before transplantation and six of the seven are alive and well without evidence of disease from 7 to 25 months after transplantation. These results suggest that cyclophosphamide alone before marrow transplantation is incapable of eradicating the abnormal clone. Cyclophosphamide combined with total body irradiation appears more effective, although more time is needed for full evaluation of results. This experience also emphasizes the importance of performing chromosome studies before transplantation for pancytopenic states in order to identify cases of preleukemia.

Adolescent↗