Considering Bone Marrow Blasts From Nonerythroid Cellularity Improves the Prognostic Evaluation of Myelodysplastic Syndromes
Por:
Arenillas L, Calvo X, Luño E, Senent L, Alonso E, Ramos F, Ardanaz MT, Pedro C, Tormo M, Marco V, Montoro J, Díez-Campelo M, Brunet S, Arrizabalaga B, Xicoy B, Andreu R, Bonanad S, Jerez A, Nomdedeu B, Ferrer A, Sanz GF and Florensa L
Publicada:
20 sep 2016
Ahead of Print:
5 jul 2016
Resumen:
Purpose
WHO classification of myeloid malignancies is based mainly on the
percentage of bone marrow (BM) blasts. This is considered from total
nucleated cells (TNCs), unless there is erythroid-hyperplasia
(erythroblasts >= 50%), calculated from nonerythroid cells (NECs). In
these instances, when BM blasts are >20%, the disorder is classified as
erythroleukemia, and when BM blasts are, <20%, as myelodysplastic
syndrome (MDS). In the latter, the percentage of blasts is considered
from TNCs.
Patients and Methods
We assessed the percentage of BM blasts from TNCs and NECs in 3,692
patients with MDS from the Grupo Espanol de Sindromes Mielodisplasicos,
465 patients with erythroid hyperplasia (MDS-E) and 3,227 patients
without erythroid hyperplasia. Weevaluated the relevance of both
quantifications on classification and prognostication.
Results
By enumerating blasts systematically from NECs, 22% of patients with
MDS-E and 12% with MDS from the whole series diagnosed within WHO
categories with, < 5% BM blasts, were reclassified into higher-risk
categories and showed a poorer overall survival than did those who
remained in initial categories (P =.006 and P =.001, respectively).
Following WHO recommendations, refractory anemia with excess blasts
(RAEB)-2 diagnosis is not possible in MDS-E, as patients with 10% to, <
20% BM blasts from TNCs fulfill erythroleukemia criteria; however, by
considering blasts from NECs, 72 patients were recoded as RAEB-2 and
showed an inferior overall survival than did patients with RAEB-1
without erythroid hyperplasia. Recalculating the International
Prognostic Scoring System by enumerating blasts from NECs in MDS-E and
in the overall MDS population reclassified approximately 9% of
lower-risk patients into higher-risk categories, which indicated the
survival expected for higher-risk patients.
Conclusion
Regardless of the presence of erythroid hyperplasia, calculating the
percentage of BM blasts from NECs improves prognostic assessment of MDS.
This fact should be considered in future WHO classification reviews.
Open Access
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