Sideroblastic Anemia in Multiple Myeloma: A Preleukemic Change

Abstract

In a 10-yr observation period, 75 patients with multiple myeloma have been studied, and 55 of these were treated daily with low dose melphalan by mouth. Of these, four developed sideroblastic anemia, manifested by anemia, thrombocytopenia, aniso-poikilocytosis, and hypochromic stippled cells in the blood, and ringed sideroblasts in the bone marrow. In two patients, this complication occurred after more than 7 yr of therapy and at a time when there was no evidence of myeloma. In a third patient, it occurred when the myeloma relapsed, and in the fourth, myeloma was active but stable. The anemia did not respond to either folate or pyridoxine. In all four patients, acute myelomonoblastic leukemia developed within 6 mo after sideroblastic anemia had been detected. These observations suggest that sideroblastic anemia in myeloma is a preleukemic manifestation.

Melphalan‐Related Leukemia in Multiple Myeloma

“…All patients had some form of cytopenia more than four months before leukemic transformation was observed. These changes during the preleukemic period correspond very well with descriptions given by other authors (9,13). The types of leukemia developing in our patients have been observed before in myeloma patients (16).…”

“…The occurrence of acute leukemia in myeloma patients has been discussed in several reports (3,7,11,13,16). It has been found that myeloma patients treated with alkylating agents run a greater risk of developing leukemia than those not treated with these agents (3).…”

“…Anisocytosis was present when anemia was observed. The erythrocyte volume was increased in four patients (MCV 9S118 fl) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] months before death. Normoblasts were found in blood smears in all patients 4-7 months before death and preceded the observation of myeloblasts by 1-4 months.…”

“…During the last ten years the connection between cytotoxic treatment and leukemia has been elucidated in several reports (18). Alkylating agents seem to be the substances most often suspected to be leukemogenic (7,8,10,11,12,13). Occurrence of leukemia in myeloma patients has been described in several reports (13,16), and some leukemia cases have been found among myeloma patients not treated with cytotoxic agents or radiotherapy (4, 16).…”

Preleukaemic Abnormal Myelopoiesis Induced by Chlorambucil: A Case Study

“…The development of acute leukaemia, lymphosarcomas or erythroleukaemias has been reported among patients who received chlorambucil for a long time (Osterberg & Randing 1970, Laroche et al 1972, Catovsky & Galton 1972, Zittoun et al 1972. Some sideroblastic anaemias have preceded for several months an acute myeloblastic leukaemia in patients with multiple myeloma treated by melphalan (Khaleeli et al 1973). There has also been established the relative frequency of acute leukaemia among patients with Hodgkin's disease treated by irradiation or prolonged chemotherapy with chlorambucil (Jacquillat et al 1973).…”