The prognostic value of circulating myeloblasts in patients with myelodysplastic syndromes (original) (raw)
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Clinical lymphoma, myeloma & leukemia, 2013
Prognosis of myelodysplastic syndromes (MDS) is an area of ongoing interest. Identification of patients with poor outcome in the categories of lower risk disease is critical. In this study, we classify a cohort of 332 lower risk MDS into 3 groups with differences in survival and risk for leukemic progression that could drive treatment approaches to improve prognosis in a fraction of these patients. Prognosis of MDS and particularly in patients categorized as lower risk (< 10% blasts or low and intermediate-1 International Prognostic Scoring System [IPSS]) is very heterogeneous and includes patients with very different outcomes with current scoring systems. Recently, a new cytogenetic classification has been proposed for the revised IPSS in predicting the outcome for MDS. To evaluate the prognostic significance of multiple variables for survival and risk of progression to acute myeloid leukemia, we analyzed baseline characteristics of 332 lower risk MDS patients within the lower r...
Evaluating the prognosis of patients with myelodysplastic syndromes
Annals of Hematology, 2002
One of the hallmarks of myelodysplastic syndromes (MDS) is their prognostic heterogeneity which complicates decision making regarding treatment for individual patients. The French-American-British (FAB) classification provides significant prognostic information, but carries the disadvantage of arbitrary demarcation of subgroups and overemphasis of morphological findings. In addition, there is considerable variation in survival and risk of acute myeloblastic leukemia (AML) development even within defined FAB subgroups, particularly in patients with refractory anemia with ring sideroblasts (RARS) and chronic myelomonocytic leukemia (CMML). Over the last 2 decades, several research groups have tried to identify additional clinical, hematological, and cell biological parameters in order to more accurately predict the natural course of MDS. These investigations have clarified that the number and extent of peripheral blood cytopenias, the bone marrow blast count, and the cytogenetic pattern are the most powerful prognostic indicators in MDS. Recent efforts have been directed at constructing prognostic scoring systems. These scoring systems try to enhance the predictive power by combining several features of the disease, which have proved their independent prognostic weight on multivariate analysis. The International MDS Risk Analysis Workshop substantially advanced the prognos-tic categorization of MDS patients by proposing a new scoring system (International Prognosis Scoring System, IPSS) that can be successfully applied to risk assessment of newly diagnosed patients and will likely prove useful for the design and analysis of therapeutic trials in MDS.
Influence of Prognostic Factors on Overall Survival in Myelodysplastic Syndromes
Materia Socio Medica, 2014
Background: Accurate prediction of a patient's prognosis is useful to define the risk posed by the disease. Age, gender, peripheral blood cytopenia, proportion of bone marrow (BM) blasts, performance status, comorbidities, transfusion dependence, specific karyotype abnormalities and molecular biomarkers can refine the prediction of prognosis in MDS. Aim: to assess the influence of the some prognostic factors like age, gender, cytopenia, BM blast percentage, transfusion dependence, ferritin, hemoglobin (Hb), lactate dehydrogenase (LDH), albumin and specific karyotype abnormalities in myelodysplastic syndromes on overall survival (OS). Patients and methods: we retrospectively analyzed the cohort of 108 patients diagnosed between 1.1.2011 and 31.12.2013 at the University Clinic of Hematology, Ss Cyril and Methodius University, Skopje, Macedonia. They were evaluated for clinical and hematologic features at diagnosis and at leukemic transformation. Results: in the study group 62 were man and 46 women. Male to female ratio was 1.35 to 1. The differences in OS between men and women were significant (p = .03015). The mean age at diagnosis was 66,6 years. According to the age OS was 16,4 months. FAB subtypes influenced OS significantly (p = .03015). OS inversely correlated with BM blast percentage (p= .02327). Cytopenia had no impact on OS (p=.33755). Hb as a whole and groups with different levels of Hb had no influence on OS (p = .12142) and (p= .07535), respectively. The group with ferritin <500 µg/L had better OS (p=.04720). Transfusion dependence, LDH and albumin had no impact on OS. Leukemic transformation was noticed in 10 (9,3%) patients. Mortality was 36,1%. Conclusion: gender, FAB subtypes, BM blast percentage and the serum levels of ferritin had an influence on OS, while age, hemoglobin level, transfusion dependence, LDH and albumin had no impact on OS.
Leukemia, 2005
Determining the percentage of peripheral blood (PB) and bone marrow (BM) blasts is important for diagnosing and classifying acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). Although most patients with acute leukemia or MDS have a higher percentage of BM blasts than PB blasts, the relative proportion is reversed in some patients. We explored the clinical relevance of this phenomenon in MDS (n ¼ 446), AML (n ¼ 1314), and acute lymphoblastic leukemia (ALL) (n ¼ 385). Among patients with MDS or ALL, but not AML, having a higher blast percentage in PB than in BM was associated with significantly shorter survival. In multivariate analyses, these associations were independent of other relevant predictors, including cytogenetic status. Our findings suggest that MDS and ALL patients who have a higher percentage of PB blasts than BM blasts have more aggressive disease. These data also suggest that MDS classification schemes should take into account the percentage of blasts in PB differently from the percentage of blasts in BM.
Leukemia Research, 2013
In 2008, the WHO proposed changes in the classification of MDS regarding RCUD and MDS unclassifiable. We validated these proposals by using 2032 patients of the Düsseldorf MDS Registry. 10% of the patients had RCUD and 6% MDS-U. Among patients with RCUD, only 9% had RN and 6% had RT. There was no correlation between dysplastic cell line and type of cytopenia. There was no difference in prognosis between RCMD and MDS-U and between RA, RT, and RN. The separation of RA, RN, and RT is not justified suggesting a consolidation as RCUD. MDS-U should be integrated into RCMD.
Some Prognostic Factors in Myelodysplastic Syndromes Can Influence Overall Survival
2016
Myelodysplastic syndromes are very heterogeneous in lot of aspects.Scientists are trying to find prognostic factors that have implication on overall survival in order to incorporate them in prognostic systems, which would enable refinement of patient‟s risk stratification.The aim of our study was evaluation of the prognostic significance of age, sex, blast percentage in bone marrow, cytopenias, MCV, transfusion dependency, serum ferritin, serum LDH, serum albumin, comorbidities, chromosomal abnormalities in MDS patients and their influence on overall survival, progression and transformation in acute myeloidleukemia. Our cohort consisted of 70 adult patients 33 women and 37 men, 66 pts with „de-novo‟ and 4 pts with therapyrelated MDS, diagnosed in the University Clinic of Hematology, “Ss Cyril and Methodius” University, Skopje, Macedonia, from January 2011 till April 2015, with the follow up period of 52 months.The univariate analysis revealed that factors associated with OS were: pl...
Prognostic factors of myelodysplastic syndromes—A simplified 3-D scoring system
Leukemia Research, 1990
From 1 January 1982 to 31 December 1986 in five haematological centers of the west of France (Rennes, Rouen, Nantes, Tours and Angers), we have collected 503 cases of myelodysplastic syndrome (MDS). These cases were classified by FAB recommendation as followed: 85 refractory anemia with ring sideroblasts (RARS); 273 refractory anemia in which 86 were without blasts (RA), 153 were with excess of blasts (RAEB) and 34 were with excess of blasts and in transformation (RAEB-t); 111 chronic myelomonocytic leukaemia (CMML); and 34 cases with borderline features. The point date for statistical study was 31 December 1988, and the scoring method of Bournemouth was applied to compare with our findings (62% resulted in death, and 18% in leukemic transformation). It was demonstrated that haemoglobin, platelets, and bone marrow-blasts are the best factors to predict survival or leukaemic transformation (LT). But peripheral neutrophils don't affect the survival time excepted when lower than 500 ~tl (13 months vs 19.6 months).
A retrospective evaluation of patients with myelodysplastic syndrome
Experimental Biomedical Research, 2019
To determine our results by examining patient's files who we followed up by myelodysplastic syndrome (MDS) diagnosis between 2005 and 2009 as retrospectively and to compare the accordance of our results with literature. Methods: We examined 55 patient's files who got MDS diagnosis in 4 year-term. Complete blood count, biochemical analysis, peripheral spread, bone marrow aspiration, bone marrow biopsy examinations, cytogenetic and fluorescence in situ hybridization (FISH) analyses were made for all cases. Results: Our patient's age average was 69 and when classified according to WHO criterion at the diagnosis time, % 13 (23,6) of cases got diagnosed with RA-RARS, % 29 (52,7) with RCMD-RS, %5 (9,1) with RAEB-1, % 4 (7.3) with RAEB-2, % 3 (5.5) with MDS 5q and % 1 (1.8) with secondary MDS. % 52 of the patients had normal cytogenetic structure. No relation was determined between patients' diagnosis and international prognostic scoring system (IPSS) scores. During the 4 year-term, our 13 patients died. 6 of these cases died by reason of transforming to acute myeloid leukemia (AML), and 7 patients died because of infection. Mean survival time of cases that died was 6 (1-7) months as of the diagnosis date. Whereas 8 cases were over 70 ages, 5 of our cases were under 70 ages. Conclusion: MDS is a disease that ranges between anemia and AML and requires cytogenetic trials for diagnosis along bone marrow aspiration and biopsy for the purpose of determining the treatment regimen and prognosis. Determining the IPSS scores of patients by obtained outcomes is required. Risk of transforming to acute leukemia and susceptibility to infection are important in terms of mortality. Overage of patient population restricts the treatment regimens. Age must be an important factor for prognosis and treatment choice.
Romanian Review of Laboratory Medicine, 2013
Myelodysplastic syndromes (MDS) are a group of heterogeneous clonal stem cell disorders characterized by ineffective hematopoiesis with dysplastic changes in one or more myeloid cell lines and increased risk of progression to acute leukemia. The current diagnosis criteria include the morphology of peripheral blood (PB) and bone marrow (BM), bone marrow biopsy and cytogenetic exam. Material and method. For this study, we have analyzed 33 patients diagnosed with lower-risk MDS (IPSS 0 and intermediate-1) according to the World Health Organization (WHO) classification (2001) between 2008 and 2012. The diagnosis was confirmed by blood cell counts, bone marrow (aspirate and biopsy) exam and cytogenetic exam. Other causes of cytopenia or dysplastic changes were excluded. Results. The types of MDS according to the WHO classification were: nine patients with refractory anemia (RA) (27.27%), sixteen patients with refractory anemia with ringed sideroblasts (RARS) (48.48%), and eight patients with refractory cytopenia with multilineage dysplasia (RCMD) (24.24%) out of which two with refractory cytopenia with multilineage dysplasia with ringed sideroblasts (RCMD-RS). Cytogenetic exam was performed in all patients, but analyzable metaphases for cytogenetic exam were obtained only from twenty five patients. The patients who did not have analyzable metaphases on cytogenetic exam were considered low risk if: they had only one cytopenia and the percent of bone marrow blasts was less than 5%. For all patients who had analyzable metaphases at cytogenetic exam, the International Prognostic Scoring System (IPSS) and Revised International Prognostic Scoring System (R-IPSS) scores were determined, and their survival and the death leading events were observed. According to IPPS (1997), the cytogenetic exam was good in 17