The uniqueness of morphological features of pure erythroid leukemia in myeloid neoplasm with erythroid predominance: A reassessment using criteria revised in the 2016 World Health Organization classification

PLoS One. 2017 Feb 14;12(2):e0172029. doi: 10.1371/journal.pone.0172029. eCollection 2017.


We reviewed 97 consecutive cases of myeloid neoplasm with erythroid predominance (MN-EP) between 2000 and 2015. Following 2016 WHO classification, MN-EP patients were classified into four groups. Eight pure erythroid leukemia (PEL) (including t-MN and AML-MRC morphologically fulfilled criteria for PEL) patients had dismal outcomes (median OS: 1 month) and showed more bone marrow fibrosis, worse performance status (PS) and higher serum lactate dehydrogenase (LDH) at diagnosis than the other groups. In the univariate analysis, risks of death in MN-EP patients included the morphologic features of PEL, very poor cytogenetic risk by IPSS-R, bone marrow fibrosis, leukocytosis, anemia, hypoalbuminemia, high LDH, and poor PS. In the multivariate analysis, independent predictors of death were morphologic features of PEL (adjusted hazards ratio [HR] 3.48, 95% confidence interval [CI] 1.24-9.74, p = 0.018), very poor cytogenetic risk by IPSS-R (adjusted HR 2.73, 95% CI 1.22-6.10, p = 0.015), hypoalbuminemia (< 3.7 g/dl) (adjusted HR 2.33, 95% CI 1.10-4.91, p = 0.026) and high serum LDH (≥ 250 U/L) (adjusted HR 2.36, 95% CI 1.28-4.36, p = 0.006). Poor or unfavorable risk in different cytogenetic risk systems independently predicted death and UKMRC-R was the best model.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Disease-Free Survival
  • Female
  • Hematologic Neoplasms* / classification
  • Hematologic Neoplasms* / diagnosis
  • Hematologic Neoplasms* / mortality
  • Hematologic Neoplasms* / therapy
  • Humans
  • Leukemia, Erythroblastic, Acute* / classification
  • Leukemia, Erythroblastic, Acute* / diagnosis
  • Leukemia, Erythroblastic, Acute* / mortality
  • Leukemia, Erythroblastic, Acute* / therapy
  • Male
  • Middle Aged
  • Risk Factors
  • Survival Rate
  • Taiwan / epidemiology

Grants and funding

This study was supported by grants from Taipei Veterans General Hospital (V105B-016 and V105E10-002-MY2-1), the Ministry of Science and Technology (MOST 104-2314-B-075-085-MY2), the Taiwan Clinical Oncology Research Foundation, Szu-Yuan Research Foundation of Internal Medicine, and Chong Hin Loon Memorial Cancer and Biotherapy Research Center at National Yang-Ming University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.