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Myelodysplastic syndromes (MDS) are haematopoietic stem-cell disorders characterised by peripheral cytopenia, dysplastic haematopoiesis, and a substantial risk of progression into acute myeloid leukaemia (AML).
We report a case of low-risk MDS, according to the international prognostic scoring systems (IPSS), which evolved into AML simultaneously to metastatic bone marrow localisation of malignant melanoma.
A 70-year-old man was diagnosed with myelodysplastic syndrome in 2006. He presented with complaints of weakness for a month. He referred arterial hypertension and myocardial infarction 3 years before, treated with coronary revascularisation. Blood analysis revealed mild macrocytic anaemia.
Bone marrow biopsy and aspirate evaluation at diagnosis showed a slightly hypercellular marrow, with significant dysplasia in the erythroid lineage, less than 5% of CD34-positive haematopoietic precursors and absence of marrow fibrosis. Cytogenetic analysis showed normal karyotype. According to the updated WHO classification, a diagnosis of refractory anaemia was made, and he was stratified as low risk by means of IPSS scoring systems.1
He was included in a clinical trial with thalidomide for 9 months, which was interrupted for inefficacy, worsening of anaemia and appearance of moderate neutropenia.
At this point, in January 2007, he was referred to our centre presenting with bicytopenia in the peripheral blood. Bone marrow re-evaluation was consistent with refractory cytopenia with multilineage …