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Myelodyspoietic syndrome associated with diethylstilbestrol therapy
Abstract:
We describe a patient with a myelodysplastic syndrome characterized by pancytopenia and an excess of myeloblasts in the bone marrow. He had received massive doses of diethylstilbestrol (150 mg daily) for seven years as therapy for prostatic carcinoma. Although myelodyspoiesis has been associated with other drugs, a relationship to estrogen therapy in man has not been reported previously. However, the administration of estrogens to animals has produced pancytopenia with a relative monocytosis and vacuolization of leukocytes. Examination of bone marroa, erythroid hypoplasia, and, with prolonged therapy, aplastic anemia. Further animal studies have demonstrated that estrogens exert a suppressive effect on marrow stem cells and granuloid progenitor cells. These experimental observations suggest a possible role of estrogens in the genesis of the hematologic changes we observed.
Insights
This study reports a case of myelodysplastic syndrome linked to high-dose estrogen therapy for prostate cancer. Animal studies support estrogens
Area of Science:
- Hematology
- Oncology
- Endocrinology
Background:
- Myelodysplastic syndromes (MDS) are a group of clonal hematopoietic stem cell disorders.
- Estrogen therapy, particularly diethylstilbestrol (DES), has been used for prostate cancer treatment.
- Drug-induced myelodysplasia is recognized, but a link to estrogen therapy in humans was previously unreported.
Observation:
- A patient developed myelodysplastic syndrome with pancytopenia and bone marrow myeloblast excess after prolonged high-dose diethylstilbestrol therapy for prostate carcinoma.
- Hematologic changes observed in the patient included pancytopenia and excess myeloblasts.
Findings:
- Animal studies demonstrated that estrogen administration can induce pancytopenia, monocytosis, leukocyte vacuolization, erythroid hypoplasia, and aplastic anemia.
- Estrogens were shown to suppress bone marrow stem cells and granuloid progenitor cells in experimental models.
- These findings suggest a potential role for estrogens in the development of observed hematologic abnormalities.
Implications:
- This case highlights a potential iatrogenic cause of myelodysplastic syndrome.
- The findings suggest that estrogen therapy may pose a risk for hematologic toxicity.
- Further investigation into the mechanisms of estrogen-induced hematologic changes is warranted.