[Erythrocyte cell aplasia in chronic myeloid leukemia--coincidence or pathogenic link]

At the Clinic for Hematology of the Military Medical Academy in Belgrade two patients had been treated from November, 1983 to July, 1986, in whom the existence of chronic myelogenous leukemia (CML) was established with negative Ph'-chromosome, as well as the existence of acquired partial erythrocyte aplasia (APEA). In the male patient of 58 years of age and the female patient of 71, APEA was established at the same time as CML. The maladies showed to be refractory to antileukemia (busulfan, hydroxyurea) and immunosuppressive (corticosteroid, androgen) therapy in both of the patients, while in the first patient splenectomy was also without effect on the course of the disease. Serumal inhibitors of erythropoiesis were not registered. After 18 months of disease duration one patient had a blastic transformation of CML into acute myeloblastic leukemia (AML) of the M1 form, and death appeared under the clinical manifestation of sepsis during iatrogenic aplasia of the bone marrow. The other patient died 32 months after start of illness because of intracranial hemorrhage, without signs of HML metamorphosis. In the discussion, previous illnesses are considered--kidney tuberculosis and polyarthralgias--as well as the applied treatment of these illnesses (antituberculotics and nonsteroid antirheumatics) as possible etiological factors in the appearance of APEA. The mutual link between APEA and CML, though exceptionally rare, is possible, and erythroblastopenia can precede or occur simultaneously with CML or during its treatment. APEA is usually the sign of CML terminal metamorphosis into acute leukemia, though it sometimes coexists with CML as an independent malady.