Acute erythroid leukemia: a reassessment using criteria refined in the 2008 WHO classification

Blood. 2010 Mar 11;115(10):1985-92. doi: 10.1182/blood-2009-09-243964. Epub 2009 Dec 29.


Acute erythroid leukemia (AEL) is a rare type of acute myeloid leukemia (AML) for which diagnostic criteria have been refined in the 2008 World Health Organization (WHO) classification of AML. The relationship of AEL to myelodysplastic syndromes (MDSs) and to AML with myelodysplasia-related changes (AML-MRC) is not clearly defined. We conducted a retrospective, multi-institutional study of patients with AEL and compared them with patients with MDS or AML-MRC with erythroid hyperplasia (> or = 50% erythroid cells). Among a total of 124 patients with AEL, 32% had a history of MDS or chronic cytopenia, 32% had therapy-related disease, and 35% had de novo disease. Sixty-four percent of patients had unfavorable AML risk-group karyotypes. FLT3 and RAS mutations were infrequent, occurring in 6% and 2%, respectively. The median overall survival (OS) of all AEL patients was 8 months, comparable with that of patients with MDS or AML-MRC with erythroid hyperplasia. The OS was related to cytogenetic risk group, but not blast count or morphologic dysplasia. Our findings suggest that AEL is in the continuum of MDS and AML with erythroid hyperplasia, where karyotype rather than an arbitrary blast cutoff represents the most important prognostic factor.

Publication types

  • Evaluation Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Chromosome Aberrations
  • Classification / methods*
  • Female
  • Humans
  • Leukemia, Erythroblastic, Acute / classification*
  • Leukemia, Erythroblastic, Acute / mortality
  • Leukemia, Erythroblastic, Acute / pathology
  • Leukemia, Erythroblastic, Acute / therapy
  • Male
  • Middle Aged
  • Polymorphism, Genetic
  • Retrospective Studies
  • Survival Analysis
  • World Health Organization*
  • Young Adult