Acute erythroid leukemia with <20% bone marrow blasts is clinically and biologically similar to myelodysplastic syndrome with excess blasts
Acute erythroid leukemia with <20% bone marrow blasts is clinically and biologically similar to myelodysplastic syndrome with excess blasts
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DOI：
10.1038/modpathol.2016.118
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发表时间：
2016-10-01
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.;Patel, Keyur P.;Hasserjian, Robert P.
在急性红白血病（红细胞/髓细胞亚型）中，原始细胞通常占总骨髓细胞的5-19%，类似于骨髓增生异常综合征亚型难治性贫血伴原始细胞过多;最近的研究提出了急性红白血病是否应被视为骨髓增生异常综合征亚型的问题。我们回顾了来自三个大型医疗中心的77例原发急性红白血病和279例原发难治性贫血伴原始细胞过多。与原始细胞过多的难治性贫血相比，急性红白血病患者的骨髓原始细胞总数较高，血小板、血红蛋白和中性粒细胞绝对计数较低，更多的患者被分配为极差核型风险和极高的修订国际预后评分系统评分。55%的急性红白血病患者接受诱导化疗，但与接受低强度治疗或支持性治疗的急性红白血病患者相比，诱导化疗与总生存期延长无关（P = 0.44）。在所有患者的多变量分析中，修订的国际预后评分系统非常高（P < 0.0001）或高（P = 0.005）风险，但不是急性红白血病的诊断（P = 0.30），是总生存期较短的独立危险因素。我们的数据显示，急性红白血病患者与难治性贫血伴原始细胞过多患者具有相似的风险调整结局，并且急性髓系白血病型诱导化疗似乎没有获得生存优势。这些数据表明，急性红白血病，红系/髓系亚型，
In acute erythroleukemia, erythroid/myeloid subtype, blasts usually comprise 5-19% of total bone marrow cells, similar to the myelodysplastic syndrome subtype refractory anemia with excess blasts; recent studies have raised the question if acute erythroleukemia should be considered as a myelodysplastic syndrome subtype. We reviewed 77 de novo acute erythroleukemia and 279 de novo refractory anemia with excess blasts from three large medical centers. Compared to refractory anemia with excess blasts, acute erythroleukemia patients had higher total bone marrow blasts, lower platelets, hemoglobin, and absolute neutrophil counts, with more patients being assigned a very-poor-karyotype risk and very-high Revised International Prognostic Scoring System score. Induction chemotherapy was administered to 55% of acute erythroleukemia patients, but was not associated with longer overall survival compared to acute erythroleukemia patients treated with lower-intensity therapies or supportive care (P = 0.44). In multivariable analysis of all patients, Revised International Prognostic Scoring System very high (P < 0.0001) or high (P = 0.005) risk, but not a diagnosis of acute erythroleukemia (P = 0.30), were independent risk factors for shorter overall survival. Our data show that acute erythroleukemia patients have similar risk-adjusted outcome to refractory anemia with excess blasts patients and do not appear to gain survival advantage with acute myeloid leukemia-type induction chemotherapy. These data suggest that acute erythroleukemia, erythroid/myeloid subtype with