Effect of chemotherapy for the dysmyelopoietic syndrome

Twenty patients are described who received chemotherapy for the diagnosis of acute myeloid leukemia but who were subsequently reclassified as having dysmyelopoietic syndrome using the French-American-British criteria. Thirteen patients had refractory anemia with excess blast cells (RAEB) (age range, 23-82 years; median, 68) and seven had chronic myelomonocytic leukemia (CMML) (age range, 44-79 years; median, 70). Three patients (two with RAEB and one with chronic myelomonocytic leukemia) had previously been treated with cytotoxic therapy for another malignancy. In 15 patients the antileukemic therapy was a chemotherapy regimen that was highly active in acute nonlymphoblastic leukemia (ie, containing daunorubicin and/or cytarabine). These patients achieved complete remission lasting 14, 34+, and 36+ months and survival times of 31, 35+, and 37+ months. All three patients were from a subgroup of four patients characterized by RAEB, younger age, no previous cytotoxic therapy, and treatment with an aggressive chemotherapy regimen. The median survival time of the patients not achieving remission was 1 month (range, less than 1-22). Our results suggest that while most patients with the dysmyelopoietic syndrome appear to have their life shortened by chemotherapy, there is a subgroup characterized by younger age, absence of previous cytotoxic therapy, and the morphologic picture of RAEB who can have a favorable response to aggressive treatment.