Erythroid-predominant myelodysplastic syndromes: enumeration of blasts from nonerythroid rather than total marrow cells provides superior risk stratification
Erythroid-predominant myelodysplastic syndromes: enumeration of blasts from nonerythroid rather than total marrow cells provides superior risk stratification
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DOI：
10.1038/modpathol.2008.142
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发表时间：
2008-11-01
期刊：
影响因子：
7.5
通讯作者：
Hasserjian, Robert P.
中科院分区：
文献类型：
--
作者：
Wang, Sa A.;Tang, Guilin;Hasserjian, Robert P.
在FAB(法国-美国-英国)和WHO(世界卫生组织)的分类中，红白血病(M6A)的原始细胞是从非红系细胞而不是总有核细胞计数的。然而，FAB或WHO的分类中都没有规定红系为主的骨髓增生异常综合征(红系母细胞=50%)的BLAST计算方法。我们检索了74例红系为主的骨髓增生异常综合征患者(占所有骨髓增生异常综合征患者的17%)和192例骨髓增生异常综合征对照患者(红细胞占50%)的档案。在红系为主的骨髓增生异常综合征中，通过计数来自骨髓非红系细胞而不是总有核细胞的原始细胞，74例患者中有41例(55%)将根据疾病亚类或国际预后评分系统进行升级。重要的是，原始细胞数=5%的患者显示出比原始细胞数=5%的患者更高的存活率(P=0.002)；当从总有核细胞计算原始细胞时，这种区别就消失了。在原始细胞数=5%的病例中，与存活率相关的是细胞遗传学而不是原始细胞计数。我们的结论是，在红系为主的骨髓增生异常综合征中，BLAST计算骨髓非红系细胞的比例而不是总有核细胞可以更好地将患者分成预后相关的组。
In the FAB (French-American-British) and WHO (World Heath Organization) classifications, the blasts in erythroleukemia (M6a) are enumerated from the marrow nonerythroid rather than the total-nucleated cells. However, the method for blast calculation in erythroid-predominant myelodysplastic syndrome (erythroblasts >= 50%) is not specified either in the FAB or WHO classifications. We retrieved the files of 74 erythroid-predominant myelodysplastic syndrome patients (17% of all myelodysplastic syndrome) and 192 myelodysplastic syndrome controls (erythroblasts < 50%). In erythroid-predominant myelodysplastic syndrome, by enumerating blasts from marrow nonerythroid cells rather than from total nucleated cells, 41 of 74 (55%) cases would be upgraded, either by disease subcategory or International Prognostic Scoring System. Importantly, the patients with >= 5% blasts demonstrated a superior survival to patients with >= 5% blasts (P = 0.002); this distinction was lost when blasts were calculated from total-nucleated cells. Of cases with >= 5% blasts, cytogenetics rather than blast count correlated with survival. We conclude that in erythroid-predominant myelodysplastic syndrome, blast calculation as a proportion of marrow nonerythroid rather than total nucleated cells can better stratify patients into prognostically relevant groups.