Simultaneous development of Crohn's disease and myelodysplastic syndrome progressing to acute myelocytic leukemia in a patient with a normal karyotype

We report seven patients with both myelodysplastic syndrome (MDS) and inflammatory bowel disease (IBD): Crohn's disease in six cases, ulcerative colitis in one case. We describe their characteristics, and those of 10 previously published similar cases are presented here. Median age at diagnosis of IBD (61 years) was high, as compared to the usual age at diagnosis of IBD. IBD was diagnosed first in nine cases, MDS first in one patient, and both diseases were diagnosed simultaneously in seven cases. Concerning IBD, there was a strong predominance of Crohn's disease (15/17 cases), with an unusually high frequency of colonic involvement (11/15 cases). MDS, in 12/17 cases, showed no excess of marrow blasts. Cytogenetic analysis was abnormal in five of the 13 evaluable cases. These observations suggest that the association between MDS and IBD may not be fortuitous in some cases, and that, in particular, patients with IBD and anemia of nonobvious origin should be evaluated for MDS. The pathogenesis of those associations, however, remains unclear.

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“…[5][6][7][8][9][10] Characteristics of those 10 cases, and of the seven cases presented here are shown in Table 1. Nine patients (53%) were male.…”

Section: Discussionmentioning

confidence: 99%

“…4 Recently, a few patients with both IBD (Crohn's disease or ulcerative colitis) and MDS have been reported, and it was suggested that the association between the two disorders was not fortuitous. [5][6][7][8][9][10][11][12] We report here seven additional cases associating MDS and IBD, and review previously published cases.…”

Section: Introductionmentioning

confidence: 99%

Association between myelodysplastic syndromes and inflammatory bowel diseases. Report of seven new cases and review of the literature

et al. 1997

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“…However, when leukopenia and thrombocytopenia are present, the possibility of other concomitant diseases (such as idiopathic thrombocytopenic purpura and pancytopenia caused by drugs) should be considered. In recent years, there have been some reports of concurrent IBD with leukemia and myelodysplastic syndrome (MDS) [2][3][4][5][6][7][8][9], but concurrent IBD and MDS cases are rare. In this study, we report nine patients with concurrent MDS and IBD treated between January 1985 and October 2006.…”

Section: Introductionmentioning

confidence: 99%

Concurrent Inflammatory Bowel Disease and Myelodysplastic Syndrome: Report of Nine New Cases and a Review of the Literature

2007

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Nine patients with concurrent myelodysplastic syndrome (MDS) and inflammatory bowel disease (IBD) were examined. Median age at diagnosis of these patients was similar to the usual age of patients at diagnosis of IBD only. There was a strong predominance of Crohn's disease (seven of nine cases), with an unusually high frequency of colorectal involvement (five of nine cases). Inflammatory bowel disease was diagnosed first in one patient, MDS first in five patients, and both diseases were diagnosed simultaneously in three patients. All patients had moderate or severe anemia. The prognosis of IBD was determined by MDS. These observations suggest that there is an unclear common pathogenesis of IBD and MDS and, consequently that patients with IBD and anemia of non-obvious origin should be evaluated for the presence of MDS.

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“…The time to onset between the initiation of AZA therapy and AL is often inconclusive (highly variable). Finally, in some patients the development of AL did precede CD [30,31] or can occur in the absence of AZA [18,30,32,33,34]. However, the association between IBD and AL has been suggested since the 1990’s [3].…”

Section: Discussionmentioning

confidence: 99%

A Case of Therapy-Related Myeloid Neoplasm in a Patient with Crohn’s Disease Treated with Azathioprine

Mullier¹,

Rahier

Maignen³

et al. 2012

Acta Haematol

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Acute leukaemia (AL) has been observed in association with Crohn’s disease (CD) notably in patients treated with azathioprine (AZA), which is an immunosuppressant known for its carcinogenicity and in particular known to induce therapy-related acute myeloid leukaemia according to the 2008 WHO classification. Whereas the link between inflammatory bowel disease and AL has been well established, the exact role of AZA remains controversial. In this paper, we report the case of a 71-year-old white Caucasian male with CD treated for 7 years with AZA who developed an acute leukaemia. Chemotherapy was administered unsuccessfully and the patient died from this haematological disorder 9 months after diagnosis. We reviewed the current evidence on the interactions between CD, AL and AZA as well as the potential underlying mechanisms of leukaemia in AZA-treated patients. From this review, we concluded that AL should be questioned when facing cytopenia in a patient with CD. The nature of the association between AZA and AL in CD patients warrants further investigation.

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Simultaneous development of Crohn's disease and myelodysplastic syndrome progressing to acute myelocytic leukemia in a patient with a normal karyotype

Cited by 15 publications

References 20 publications

Association between myelodysplastic syndromes and inflammatory bowel diseases. Report of seven new cases and review of the literature

Association between myelodysplastic syndromes and inflammatory bowel diseases. Report of seven new cases and review of the literature

Concurrent Inflammatory Bowel Disease and Myelodysplastic Syndrome: Report of Nine New Cases and a Review of the Literature

A Case of Therapy-Related Myeloid Neoplasm in a Patient with Crohn’s Disease Treated with Azathioprine

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