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Vido JR, Adam RL, Lorand-Metze IGH, Metze K. Computerized texture analysis of atypical immature myeloid precursors in patients with myelodysplastic syndromes: an entity between blasts and promyelocytes. Diagn Pathol 2011; 6:93. [PMID: 21958512 PMCID: PMC3195698 DOI: 10.1186/1746-1596-6-93] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 09/29/2011] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Bone marrow (BM) blast count is an essential parameter for classification and prognosis of myelodysplastic syndromes (MDS). However, a high degree of cell atypias in bone marrow hemopoietic cells may be found in this group of clonal disorders, making it difficult to quantify precisely myeloblasts, and to distinguish them from promyelocytes and atypical immature myeloid precursors. Our aim was to investigate whether computerized image analysis of routine cytology would help to characterize these cells. METHODS In May-Grünwald-Giemsa stained BM smears of 30 newly diagnosed MDS patients and 19 cases of normal BM, nuclei of blasts and promyelocytes were digitalized and interactively segmented. The morphological classification of the cells was done by consensus of two observers. Immature granulocytic precursors, which could not be clearly classified either as blasts or promyelocytes, were called "atypic myeloid precursors". Nuclear morphometry and texture features derived from the co-occurrence matrix and fractal dimension (FD) were calculated. RESULTS In normal BM, when compared to myeloblasts, nuclei of promyelocytes showed significant increase in perimeter and local texture homogeneity and a decrease in form factor, chromatin gray levels, Haralick's entropy, inertia, energy, contrast, diagonal moment, cluster prominence, the fractal dimension according to Minkowski and its goodness-of-fit. Compared to normal myeloblast nuclei, the chromatin texture of MDS myeloblasts revealed higher local homogeneity and goodness-of-fit of the FD, but lower values of entropy, contrast, diagonal moment, and fractal dimension. The same differences were found between nuclei of normal promyelocytes and those of MDS. Nuclei of atypical myeloid precursors showed intermediate characteristics between those of blasts and promyelocytes according to the quantitative features (perimeter, form factor, gray level and its standard deviation), but were similar to promyelocytes according to the texture variables inertia, energy, contrast, diagonal moment, cluster prominence, and Minkowski's fractal dimension. CONCLUSION BM atypical immature myeloid precursors are difficult to be correctly classified in routine cytology. Although their cytoplasm is more similar to that of myeloblasts, computerized texture analysis indicates a nuclear chromatin remodeling more close to the promyelocyte, thus indicating an asynchronous intermediate maturation stage between blast and promyelocyte.
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Affiliation(s)
- Joyce R Vido
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Rua Tessalia Vieira de Camargo 126, 13083-887, Campinas, Brazil
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Moon JH, Lee SJ, Lee YJ, Kang BW, Chae YS, Kim JG, Suh JS, Sohn SK. Pilot study on combination of azacitidine and low-dose cytarabine for patients with refractory anemia with excess blast. Ann Hematol 2011; 91:367-73. [DOI: 10.1007/s00277-011-1321-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 08/22/2011] [Indexed: 10/17/2022]
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253
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Valent P, Bain BJ, Bennett JM, Wimazal F, Sperr WR, Mufti G, Horny HP. Idiopathic cytopenia of undetermined significance (ICUS) and idiopathic dysplasia of uncertain significance (IDUS), and their distinction from low risk MDS. Leuk Res 2011; 36:1-5. [PMID: 21920601 DOI: 10.1016/j.leukres.2011.08.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 08/01/2011] [Accepted: 08/18/2011] [Indexed: 10/17/2022]
Abstract
It is now generally appreciated that hematologic neoplasms can develop over many years if not decades, often being initially occult or showing minimal (subdiagnostic) abnormalities. However, whereas such early neoplastic conditions have been defined in some detail in lymphoproliferative neoplasms, little is known about minimal lesions preceding the manifestation of an overt myeloid neoplasm, about underlying mechanisms, the clinical course and outcome, and the prognostic significance of such conditions. Members of several groups have recently described two 'premalignant' myeloid conditions, namely idiopathic cytopenia of undetermined significance (ICUS) and idiopathic bone marrow dysplasia of uncertain significance (IDUS). At least in some patients these are neoplastic conditions. Both conditions may progress to an overt myelodysplastic syndrome (MDS), but may also progress to another myeloid neoplasm such as acute myeloid leukemia, a myeloproliferative neoplasm (MPN), or a mast cell disorder (mastocytosis). In ICUS the dysplasia is mild and does not fulfill the WHO criteria for MDS but cytopenias can be severe. In IDUS the dysplasia is prominent but cytopenias, if detectable, are mild. In both conditions it is possible that a neoplastic clone has already replaced most or all of normal bone marrow cells when ICUS or IDUS is detected, but evidence to support this possibility is not necessarily available. For both groups of patients we recommend a thorough hematologic follow up because of the potential of disease-manifestation and the unpredictable form and time of progression. In the present review, we discuss current concepts relating to ICUS and IDUS as well as diagnostic approaches and available criteria.
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Affiliation(s)
- Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria.
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254
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Zinke-Cerwenka W, Valentin A, Posch U, Beham-Schmid C, Groselj-Strele A, Linkesch W, Wölfler A, Sill H. Reduced-intensity allografting in patients with therapy-related myeloid neoplasms and active primary malignancies. Bone Marrow Transplant 2011; 46:1540-4. [PMID: 21860429 DOI: 10.1038/bmt.2011.165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Therapy-related myeloid neoplasms (t-MNs) are severe long-term consequences of cytotoxic treatments for a primary, often, malignant disorder. So far, the majority of patients eligible for transplantation have undergone myeloablative allo haematopoietic SCT (HSCT) as a potentially curative treatment, but it has been associated with high transplantation-related mortality (TRM) rates. In this retrospective study, we analysed the outcome of patients with t-MNs undergoing HSCT with reduced-intensity conditioning (RIC). Of 55 patients, seen at a single centre over a 10-year period, 17 underwent RIC HSCT with related or unrelated donors. The estimated overall survival was 53% at 1 year and 47% at 3 years, and disease-free survival was 47% at 1 year. At 1 year, the cumulative incidence of relapse and TRM were 24% and 30%, respectively. Of five patients with active primary neoplasms who underwent transplantation, two are alive beyond 1 year and show CR of both t-MNs and the primary malignancy. These data indicate that RIC HSCT is an encouraging approach for patients with t-MNs. The issue of primary malignancies not being in remission at the time of transplantation should be explored in further studies.
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Affiliation(s)
- W Zinke-Cerwenka
- Division of Haematology, Medical University of Graz, Graz, Austria
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255
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Falco P, Levis A, Stacchini A, Ciriello MM, Geuna M, Notari P, Omedè P, Pautasso M, Prato G, Strola G, Gioia D, Bonferroni M, Cametti G, Ferrero D, Freilone R, Gaidano G, Marinone C, Marmont F, Pollio B, Salvi F, Saglio G, Girotto M. Prognostic relevance of cytometric quantitative assessment in patients with myelodysplastic syndromes. Eur J Haematol 2011; 87:409-18. [PMID: 21711395 DOI: 10.1111/j.1600-0609.2011.01676.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Morphology and cytogenetics are currently used to define prognosis in myelodysplastic syndromes (MDS). However, these parameters have some limits. Flow cytometry has been recently included in the diagnostic panel for MDS, and its prognostic significance is under evaluation. METHODS Marrow aspirates from 424 MDS patients were analyzed by flow cytometry to evaluate the impact of bone marrow cell immunophenotype on overall survival (OS) and leukemia-free survival (LFS). The immature compartment of myeloblasts was analyzed by the quantitative expression of CD34 (<3% vs. ≥3%), CD117, and CD11b(-) /CD66b(-) (<5% vs. ≥5%); myeloid maturation was analyzed by the expression of CD11b(+) /CD66b(++) (<15% vs. ≥15%) and CD11b(+) /CD66b(+) (<25% vs. ≥25%). RESULTS In univariate analysis, the expression of immaturity markers (CD34(+) , CD117(+) , and CD11b(-) /CD66b(-) ) was associated with shorter LFS and OS (P < 0.0001); higher expression of differentiation markers (CD11b(+) /CD66b(++) and CD11b(+) /CD66b(+) ) was associated with longer LFS (P < 0.0001 and P = 0.0002, respectively) and OS (P < 0.0001). In multivariate analysis, expression of CD34(+) (P = 0.007), CD117(+) (P = 0.013), and CD11b(+) /CD66b(++) (P = 0.023) retained independent prognostic value for OS, while only the expression of CD34(+) was a prognostic factor for LFS (P = 0.0003). Two different risk groups were defined according to the presence of 0-1 or ≥2 of these factors with significant different LFS and OS (P < 0.0001). This score showed prognostic value in predicting survival even in subanalysis according to IPSS and WHO subgroups. CONCLUSIONS Flow cytometric analysis in MDS may provide meaningful prognostic information. Blast percentage expressed as CD117(+) or CD34(+) cells and the quantitative assessment of myeloid maturation showed prognostic value for survival.
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Affiliation(s)
- Patrizia Falco
- Division of Hematology and Transfusional Medicine ASLTO4, Via Marchesi della Rocca 30, Ciriè, Turin.
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Al-Ameri A, Cherry M, Garcia-Manero G, Quintás-Cardama A. Standard therapy for patients with myelodysplastic syndromes. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2011; 11:303-13. [PMID: 21816368 DOI: 10.1016/j.clml.2011.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 01/06/2011] [Accepted: 01/28/2011] [Indexed: 02/03/2023]
Abstract
The myelodysplastic syndromes (MDS) are a group of clonal hematopoietic stem cell disorders characterized by cytopenias, dysplastic changes in the hematopoietic precursors, and an increased risk of evolving into acute leukemia. Treatment for patients with MDS ranges from supportive care with blood products and/or growth factors up to allogeneic stem cell transplantation. Over the past decade, several novel therapeutic agents have been approved for clinical use. In this article, the current approach for the management of patients with MDS according to their risk category is described and mainly focuses on approved novel agents.
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Affiliation(s)
- Ali Al-Ameri
- Department of Leukemia, MD Anderson Cancer Center, The University of Texas, Houston, TX 77030, USA
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257
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Clinical utility of the neutrophil distribution pattern obtained using the CELL-DYN SAPPHIRE hematology analyzer for the diagnosis of myelodysplastic syndrome. Int J Hematol 2011; 94:169-177. [DOI: 10.1007/s12185-011-0892-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 06/20/2011] [Accepted: 06/20/2011] [Indexed: 11/27/2022]
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258
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Belli CB, Bengió R, Aranguren PN, Sakamoto F, Flores MG, Watman N, Nucifora E, Prates MV, Arbelbide J, Larripa I. Partial and total monosomal karyotypes in myelodysplastic syndromes: comparative prognostic relevance among 421 patients. Am J Hematol 2011; 86:540-5. [PMID: 21674572 DOI: 10.1002/ajh.22034] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 03/11/2011] [Accepted: 03/14/2011] [Indexed: 11/08/2022]
Abstract
Myelodysplastic syndromes (MDS) include a group of heterogeneous hematological disorders with a variable risk of leukemic evolution and short survival. Around 40-50% of patients show abnormal karyotypes that are mostly characterized by monosomies or deletions. Cytogenetic findings are an independent prognostic factor and the International prognostic scoring system (IPSS) differentiates three cytogenetic categories, despite the Intermediate one being heterogeneous. The aim of this study, including 421 Argentinean patients with primary MDS, is to characterize the cytogenetic profile, to test its prognostic value and to compare partial and monosomal karyotypes against other cytogenetic findings. An abnormal karyotype (median survival: 26 months) was observed in 176 patients. The presence of complex karyotypes, number of alterations, and the IPSS cytogenetic groups showed significant differences for predicting outcome. Behavior of patients with isolated deletions (median survival: 49 months) did not differ from those with normal karyotype (56 months, P = 0.654) or Good prognostic findings (43 months, P = 0.371). However, a worse prognosis was observed when another alteration was added (31 months, P = 0.043). Karyotypes with autosomal monosomies (median survival: 16 months) had a prognostic impact similar to other Poor cytogenetic findings (17 months, P = 0.626). In our population classified according to French-American-British (FAB) or World Health Organization (WHO), this new categorization of cytogenetic abnormalities, recognizing three different risk groups, showed an independent prognostic impact and a better discriminating power than the IPSS categories. It can be concluded that all isolate deletions (excluding 7q-) are good prognostic findings and all monosomies (excluding Y chromosome loss) are bad indicators.
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Affiliation(s)
- Carolina B Belli
- Instituto de Investigaciones Hematológicas, Academia Nacional de Medicina, Buenos Aires, Argentina.
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259
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van de Loosdrecht AA, Westers TM. Flow cytometry in myelodysplastic syndromes: Ready for translation into clinical practice. Leuk Res 2011; 35:850-2. [DOI: 10.1016/j.leukres.2011.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 03/21/2011] [Accepted: 03/23/2011] [Indexed: 10/18/2022]
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260
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Economic analysis of decitabine versus best supportive care in the treatment of intermediate- and high-risk myelodysplastic syndromes from a US payer perspective. Clin Ther 2011; 32:2444-56. [PMID: 21353113 DOI: 10.1016/j.clinthera.2010.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Myelodysplastic syndromes (MDS) are blood and bone marrow disorders that occur primarily in the elderly population, with 30% of all cases progressing to acute myeloid leukemia (AML). Red blood cell transfusions--a conventional treatment of MDS--have been associated with high costs and decreased quality of life compared with transfusion independence. Phase III clinical trial data suggest that decitabine may offer an improved AML-free survival versus best supportive care (BSC), which consists of red blood cell transfusions, deferoxamine, erythropoiesis-stimulating agents, platelet transfusions, and colony-stimulating factors. The US Food and Drug Administration has approved a 5-day outpatient decitabine dosing regimen, which might reduce administration costs compared with the standard 3-day inpatient regimen. OBJECTIVE The aim of this study was to assess the cost-effectiveness of 5-day dosing of decitabine versus BSC in US patients with intermediate- and high-risk MDS from a US payer perspective. METHODS A Markov model with 3 health states (MDS, AML, and death) was constructed to simulate natural disease progression. The model followed patients in 4-week cycles for ≤ 5 years. Clinical inputs and patient characteristics were based on decitabine Phase III clinical trial data. Costs of supportive care and adverse events were based on trial resource utilization data. Drug and AML costs were obtained from published sources. Deterministic and probabilistic sensitivity analyses were performed to determine the impact of model parameters on results. RESULTS In the base-case model, decitabine yielded 0.276 additional year of AML-free survival and 0.052 more quality-adjusted life-year (QALY) compared with BSC. Total decitabine and administration costs over the 5-year time horizon were $28,933. Total direct medical costs were $122,940 in the decitabine arm and $122,666 in the BSC arm. The incremental cost-effectiveness ratio for decitabine versus BSC was $5277 per QALY gained. Sensitivity analyses indicated that decitabine had a higher probability than BSC of being cost-effective despite the uncertainty around some model parameters, including survival. CONCLUSION In this study, decitabine administered on a 5-day dosing schedule was likely a cost-effective treatment option in patients with intermediate- and high-risk MDS from a US payer perspective.
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261
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Della Porta MG, Lanza F, Del Vecchio L. Flow cytometry immunophenotyping for the evaluation of bone marrow dysplasia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2011; 80:201-11. [PMID: 21674774 DOI: 10.1002/cyto.b.20607] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 05/06/2011] [Accepted: 05/17/2011] [Indexed: 01/28/2023]
Abstract
The pathological hallmark of myelodysplastic syndromes (MDS) is marrow dysplasia, which represents the basis of the WHO classification of these disorders. This classification provides clinicians with a useful tool for defining the different subtypes of MDS and determining individual prognosis. The WHO proposal has raised some concern regarding minimal diagnostic criteria particularly in patients with normal karyotype without robust morphological markers of dysplasia (such as ring sideroblasts or excess of blasts). Therefore, there is clearly a need to refine the accuracy to detect marrow dysplasia. Flow cytometry (FCM) immunophenotyping has been proposed as a tool to improve the evaluation of marrow dysplasia. Rationale for the application of FCM in the diagnostic work up of MDS is that immunophenotyping is an accurate method for quantitative and qualitative evaluation of hematopoietic cells and that MDS have been found to have abnormal expression of several cellular antigens. To become clinically applicable, FCM analysis should be based on parameters with sufficient specificity and sensitivity, data should be reproducible between different operators and the results should be easily understood by clinicians. In this report, we reviewed the most relevant progresses in detection of marrow dysplasia by FCM in MDS as defined by WHO criteria.
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Affiliation(s)
- Matteo Giovanni Della Porta
- Department of Hematology Oncology, University of Pavia Medical School and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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262
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Perbellini O, Zamò A, Colarossi S, Zampieri F, Zoppi F, Bonadonna P, Schena D, Artuso A, Martinelli G, Chilosi M, Pizzolo G, Zanotti R. Primary role of multiparametric flow cytometry in the diagnostic work-up of indolent clonal mast cell disorders. CYTOMETRY PART B-CLINICAL CYTOMETRY 2011; 80:362-8. [PMID: 21656905 DOI: 10.1002/cyto.b.20606] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 04/08/2011] [Accepted: 05/10/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND According to the World Health Organization (WHO) classification the diagnosis of systemic mastocytosis (SM) relies on bone marrow (BM) examination and is based on one major and four minor criteria. Herein, we used WHO criteria to compare flow cytometry (FC) with other available techniques in the diagnosis of SM after BM examination. METHODS We analyzed a cohort of 95 patients with suspect SM. All patients underwent comprehensive BM examination by using cytology, immunohistochemistry, FC and molecular study for mutation of c-Kit and serum tryptase dosage. FC evaluation was based on a combination of monoclonal antibodies, specifically CD25/CD2/CD45/CD34/CD117. RESULTS Seventy-four out of ninety-five patients were diagnosed with indolent SM (n = 59) or monoclonal mast cell activation syndrome (n = 15) because satisfying less than 3 minor criteria. Thirty-nine out of these seventy-four patients fulfilled the major histological criterion, whereas the presence of a minor criterion was assessed by FC, molecular study, cytology, and tryptase level in 70/74, 52/67, 56/74, and 42/74 patients, respectively. FC showed higher sensitivity than IHC in detection of CD25+ mast cells (MC) (92.9% vs. 73.8%; P = 0.019), especially in the absence of the major histological criterion (90.5% vs. 47.6%; P = 0.003). Moreover, CD2 expression was documented by FC and IHC in 97.1% and 35.3% of cases, respectively (P < 0.001). CONCLUSIONS FC showed the best sensitivity for identifying abnormal MC compared to other techniques, especially in cases with low MC burden. Therefore, we hope for a major role of FC in the diagnostic work-up of clonal MC disorders.
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Affiliation(s)
- Omar Perbellini
- Department of Medicine, Section of Hematology, Azienda Ospedaliera Universitaria Integrata and University of Verona, Italy.
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263
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Standards and impact of hematopathology in myelodysplastic syndromes (MDS). Oncotarget 2011; 1:483-96. [PMID: 21317447 DOI: 10.18632/oncotarget.101104] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The diagnosis, classification, and prognostication of patients with myelodysplastic syndromes (MDS) are usually based on clinical parameters, analysis of peripheral blood and bone marrow smears, and cytogenetic determinants. However, a thorough histologic and immunohistochemical examination of the bone marrow is often required for a final diagnosis and exact classification in these patients. Notably, histology and immunohistology may reveal dysplasia in megakaryocytes or other bone marrow lineages and/or the presence of clusters of CD34-positive precursor cells. In other cases, histology may reveal an unrelated or co-existing hematopoietic neoplasm, or may support the conclusion the patient is suffering from acute myeloid leukemia rather than MDS. Moreover, histologic investigations and immunohistology may reveal an increase in tryptase-positive cells, a coexisting systemic mastocytosis, or bone marrow fibrosis, which is of prognostic significance. To discuss diagnostic algorithms, terminologies, parameters, and specific issues in the hematopathologic evaluation of MDS, a Working Conference involving a consortium of US and EU experts, was organized in June 2010. The outcomes of the conference and resulting recommendations provided by the faculty, are reported in this article. These guidelines should assist in the diagnosis, classification, and prognostication in MDS in daily practice as well as in clinical trials.
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264
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Clissa C, Finelli C, de Vivo A. Le sindromi mielodisplastiche: diagnosi, prognosi e terapia. ITALIAN JOURNAL OF MEDICINE 2011. [DOI: 10.1016/j.itjm.2010.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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265
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Martínez-Francés A. Adverse effects of azacitidine: onset, duration, and treatment. Adv Ther 2011; 28 Suppl 4:1-5. [PMID: 21688206 DOI: 10.1007/s12325-011-0021-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Indexed: 11/29/2022]
Abstract
High-risk myelodysplastic syndromes present a poor prognosis, with survivals of close to only 1 year. The use of azacitidine, a DNA methyltransferase inhibitor, in this group of patients has transformed this grey image, with a demonstrated improvement in survival. Responses to survival are attained in a progressive manner, providing that the drug is used continually. This requires a good control of the adverse effects of the drug, which are primarily in the first cycles of treatment. The hematological adverse effects can be handled with transfusions and growth factors. The nonhematological adverse effects can be prevented with the use of antiemetics and a good technique of drug administration.
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266
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Schanz J, Steidl C, Fonatsch C, Pfeilstöcker M, Nösslinger T, Tuechler H, Valent P, Hildebrandt B, Giagounidis A, Aul C, Lübbert M, Stauder R, Krieger O, Garcia-Manero G, Kantarjian H, Germing U, Haase D, Estey E. Coalesced multicentric analysis of 2,351 patients with myelodysplastic syndromes indicates an underestimation of poor-risk cytogenetics of myelodysplastic syndromes in the international prognostic scoring system. J Clin Oncol 2011; 29:1963-70. [PMID: 21519021 PMCID: PMC4874202 DOI: 10.1200/jco.2010.28.3978] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The International Prognostic Scoring System (IPSS) remains the most commonly used system for risk classification in myelodysplastic syndromes (MDSs). The IPSS gives more weight to blast count than to cytogenetics. However, previous publications suggested that cytogenetics are underweighted in the IPSS. Here we investigate the prognostic impact of cytogenetic subgroups compared with that of bone marrow blast count in a large, multicentric, international patient cohort. PATIENTS AND METHODS In total, 2,351 patients with MDS who have records in the German-Austrian and the MD Anderson Cancer Center databases were included and analyzed in univariate and multivariate models regarding overall survival and risk of transformation to acute myeloid leukemia (AML). The data were analyzed separately for patients treated with supportive care without specific therapy, with AML-like chemotherapy, or with other therapy regimens (low-dose chemotherapy, demethylating agents, immune modulating agents, valproic acid, and cyclosporine). RESULTS The prognostic impact of poor-risk cytogenetic findings (as defined by the IPSS classification) on overall survival was as unfavorable as an increased (> 20%) blast count. The hazard ratio (compared with an abnormal karyotype or a bone marrow blast count < 5%) was 3.3 for poor-risk cytogenetics, 4.8 for complex abnormalities harboring chromosomes 5 and/or 7, and 3.1 for a blast count of 21% to 30% (P < .01 for all categories). The predictive power of the IPSS cytogenetic subgroups was unaffected by type of therapy given. CONCLUSION The independent prognostic impact of poor-risk cytogenetics on overall survival is equivalent to the impact of high blast counts. This finding should be considered in the upcoming revision of the IPSS.
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Affiliation(s)
- Julie Schanz
- From the University of Goettingen, Goettingen; University of Duesseldorf, Duesseldorf; Johannes Hospital, Duisburg; University of Freiburg, Freiburg, Germany; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Medical University of Vienna; Hanusch Hospital, L. Boltzmann Institute for Leukemia Research; Medical University of Vienna, Vienna; Medical University of Innsbruck, Innsbruck; Elisabethinen Hospital, Linz, Austria; MD Anderson Cancer Center, Houston, TX; and Seattle Cancer Care Alliance, Seattle, WA
| | - Christian Steidl
- From the University of Goettingen, Goettingen; University of Duesseldorf, Duesseldorf; Johannes Hospital, Duisburg; University of Freiburg, Freiburg, Germany; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Medical University of Vienna; Hanusch Hospital, L. Boltzmann Institute for Leukemia Research; Medical University of Vienna, Vienna; Medical University of Innsbruck, Innsbruck; Elisabethinen Hospital, Linz, Austria; MD Anderson Cancer Center, Houston, TX; and Seattle Cancer Care Alliance, Seattle, WA
| | - Christa Fonatsch
- From the University of Goettingen, Goettingen; University of Duesseldorf, Duesseldorf; Johannes Hospital, Duisburg; University of Freiburg, Freiburg, Germany; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Medical University of Vienna; Hanusch Hospital, L. Boltzmann Institute for Leukemia Research; Medical University of Vienna, Vienna; Medical University of Innsbruck, Innsbruck; Elisabethinen Hospital, Linz, Austria; MD Anderson Cancer Center, Houston, TX; and Seattle Cancer Care Alliance, Seattle, WA
| | - Michael Pfeilstöcker
- From the University of Goettingen, Goettingen; University of Duesseldorf, Duesseldorf; Johannes Hospital, Duisburg; University of Freiburg, Freiburg, Germany; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Medical University of Vienna; Hanusch Hospital, L. Boltzmann Institute for Leukemia Research; Medical University of Vienna, Vienna; Medical University of Innsbruck, Innsbruck; Elisabethinen Hospital, Linz, Austria; MD Anderson Cancer Center, Houston, TX; and Seattle Cancer Care Alliance, Seattle, WA
| | - Thomas Nösslinger
- From the University of Goettingen, Goettingen; University of Duesseldorf, Duesseldorf; Johannes Hospital, Duisburg; University of Freiburg, Freiburg, Germany; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Medical University of Vienna; Hanusch Hospital, L. Boltzmann Institute for Leukemia Research; Medical University of Vienna, Vienna; Medical University of Innsbruck, Innsbruck; Elisabethinen Hospital, Linz, Austria; MD Anderson Cancer Center, Houston, TX; and Seattle Cancer Care Alliance, Seattle, WA
| | - Heinz Tuechler
- From the University of Goettingen, Goettingen; University of Duesseldorf, Duesseldorf; Johannes Hospital, Duisburg; University of Freiburg, Freiburg, Germany; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Medical University of Vienna; Hanusch Hospital, L. Boltzmann Institute for Leukemia Research; Medical University of Vienna, Vienna; Medical University of Innsbruck, Innsbruck; Elisabethinen Hospital, Linz, Austria; MD Anderson Cancer Center, Houston, TX; and Seattle Cancer Care Alliance, Seattle, WA
| | - Peter Valent
- From the University of Goettingen, Goettingen; University of Duesseldorf, Duesseldorf; Johannes Hospital, Duisburg; University of Freiburg, Freiburg, Germany; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Medical University of Vienna; Hanusch Hospital, L. Boltzmann Institute for Leukemia Research; Medical University of Vienna, Vienna; Medical University of Innsbruck, Innsbruck; Elisabethinen Hospital, Linz, Austria; MD Anderson Cancer Center, Houston, TX; and Seattle Cancer Care Alliance, Seattle, WA
| | - Barbara Hildebrandt
- From the University of Goettingen, Goettingen; University of Duesseldorf, Duesseldorf; Johannes Hospital, Duisburg; University of Freiburg, Freiburg, Germany; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Medical University of Vienna; Hanusch Hospital, L. Boltzmann Institute for Leukemia Research; Medical University of Vienna, Vienna; Medical University of Innsbruck, Innsbruck; Elisabethinen Hospital, Linz, Austria; MD Anderson Cancer Center, Houston, TX; and Seattle Cancer Care Alliance, Seattle, WA
| | - Aristoteles Giagounidis
- From the University of Goettingen, Goettingen; University of Duesseldorf, Duesseldorf; Johannes Hospital, Duisburg; University of Freiburg, Freiburg, Germany; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Medical University of Vienna; Hanusch Hospital, L. Boltzmann Institute for Leukemia Research; Medical University of Vienna, Vienna; Medical University of Innsbruck, Innsbruck; Elisabethinen Hospital, Linz, Austria; MD Anderson Cancer Center, Houston, TX; and Seattle Cancer Care Alliance, Seattle, WA
| | - Carlo Aul
- From the University of Goettingen, Goettingen; University of Duesseldorf, Duesseldorf; Johannes Hospital, Duisburg; University of Freiburg, Freiburg, Germany; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Medical University of Vienna; Hanusch Hospital, L. Boltzmann Institute for Leukemia Research; Medical University of Vienna, Vienna; Medical University of Innsbruck, Innsbruck; Elisabethinen Hospital, Linz, Austria; MD Anderson Cancer Center, Houston, TX; and Seattle Cancer Care Alliance, Seattle, WA
| | - Michael Lübbert
- From the University of Goettingen, Goettingen; University of Duesseldorf, Duesseldorf; Johannes Hospital, Duisburg; University of Freiburg, Freiburg, Germany; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Medical University of Vienna; Hanusch Hospital, L. Boltzmann Institute for Leukemia Research; Medical University of Vienna, Vienna; Medical University of Innsbruck, Innsbruck; Elisabethinen Hospital, Linz, Austria; MD Anderson Cancer Center, Houston, TX; and Seattle Cancer Care Alliance, Seattle, WA
| | - Reinhard Stauder
- From the University of Goettingen, Goettingen; University of Duesseldorf, Duesseldorf; Johannes Hospital, Duisburg; University of Freiburg, Freiburg, Germany; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Medical University of Vienna; Hanusch Hospital, L. Boltzmann Institute for Leukemia Research; Medical University of Vienna, Vienna; Medical University of Innsbruck, Innsbruck; Elisabethinen Hospital, Linz, Austria; MD Anderson Cancer Center, Houston, TX; and Seattle Cancer Care Alliance, Seattle, WA
| | - Otto Krieger
- From the University of Goettingen, Goettingen; University of Duesseldorf, Duesseldorf; Johannes Hospital, Duisburg; University of Freiburg, Freiburg, Germany; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Medical University of Vienna; Hanusch Hospital, L. Boltzmann Institute for Leukemia Research; Medical University of Vienna, Vienna; Medical University of Innsbruck, Innsbruck; Elisabethinen Hospital, Linz, Austria; MD Anderson Cancer Center, Houston, TX; and Seattle Cancer Care Alliance, Seattle, WA
| | - Guillermo Garcia-Manero
- From the University of Goettingen, Goettingen; University of Duesseldorf, Duesseldorf; Johannes Hospital, Duisburg; University of Freiburg, Freiburg, Germany; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Medical University of Vienna; Hanusch Hospital, L. Boltzmann Institute for Leukemia Research; Medical University of Vienna, Vienna; Medical University of Innsbruck, Innsbruck; Elisabethinen Hospital, Linz, Austria; MD Anderson Cancer Center, Houston, TX; and Seattle Cancer Care Alliance, Seattle, WA
| | - Hagop Kantarjian
- From the University of Goettingen, Goettingen; University of Duesseldorf, Duesseldorf; Johannes Hospital, Duisburg; University of Freiburg, Freiburg, Germany; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Medical University of Vienna; Hanusch Hospital, L. Boltzmann Institute for Leukemia Research; Medical University of Vienna, Vienna; Medical University of Innsbruck, Innsbruck; Elisabethinen Hospital, Linz, Austria; MD Anderson Cancer Center, Houston, TX; and Seattle Cancer Care Alliance, Seattle, WA
| | - Ulrich Germing
- From the University of Goettingen, Goettingen; University of Duesseldorf, Duesseldorf; Johannes Hospital, Duisburg; University of Freiburg, Freiburg, Germany; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Medical University of Vienna; Hanusch Hospital, L. Boltzmann Institute for Leukemia Research; Medical University of Vienna, Vienna; Medical University of Innsbruck, Innsbruck; Elisabethinen Hospital, Linz, Austria; MD Anderson Cancer Center, Houston, TX; and Seattle Cancer Care Alliance, Seattle, WA
| | - Detlef Haase
- From the University of Goettingen, Goettingen; University of Duesseldorf, Duesseldorf; Johannes Hospital, Duisburg; University of Freiburg, Freiburg, Germany; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Medical University of Vienna; Hanusch Hospital, L. Boltzmann Institute for Leukemia Research; Medical University of Vienna, Vienna; Medical University of Innsbruck, Innsbruck; Elisabethinen Hospital, Linz, Austria; MD Anderson Cancer Center, Houston, TX; and Seattle Cancer Care Alliance, Seattle, WA.,Corresponding author: Detlef Haase, PhD, Department of Hematology and Oncology, Georg-August-University, Robert-Koch-Str 40, 37075 Goettingen, Germany; e-mail:
| | - Elihu Estey
- From the University of Goettingen, Goettingen; University of Duesseldorf, Duesseldorf; Johannes Hospital, Duisburg; University of Freiburg, Freiburg, Germany; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Medical University of Vienna; Hanusch Hospital, L. Boltzmann Institute for Leukemia Research; Medical University of Vienna, Vienna; Medical University of Innsbruck, Innsbruck; Elisabethinen Hospital, Linz, Austria; MD Anderson Cancer Center, Houston, TX; and Seattle Cancer Care Alliance, Seattle, WA
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267
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Affiliation(s)
- Henrik Hasle
- Department of Paediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark.
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268
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Loeffler-Ragg J, Germing U, Sperr W, Herrmann H, Zwierzina H, Valent P, Ulmer H, Stauder R. Serum CD44 levels predict survival in patients with low-risk myelodysplastic syndromes. Crit Rev Oncol Hematol 2011; 78:150-61. [DOI: 10.1016/j.critrevonc.2010.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 05/20/2010] [Accepted: 05/28/2010] [Indexed: 10/19/2022] Open
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269
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Aggarwal S, van de Loosdrecht AA, Alhan C, Ossenkoppele GJ, Westers TM, Bontkes HJ. Role of immune responses in the pathogenesis of low-risk MDS and high-risk MDS: implications for immunotherapy. Br J Haematol 2011; 153:568-81. [DOI: 10.1111/j.1365-2141.2011.08683.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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270
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Caocci G, La Nasa G, Efficace F. Health-related quality of life and symptom assessment in patients with myelodysplastic syndromes. Expert Rev Hematol 2011; 2:69-80. [PMID: 21082996 DOI: 10.1586/17474086.2.1.69] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Health-related quality of life (HRQOL), symptom burden and other types of patient-reported outcomes have acquired an important role in clinical research, as they can provide precious information on the patient's perspective of disease symptoms and treatment-related effects. HRQOL in patients with myelodysplastic syndromes (MDSs) may be compromised for several reasons, including severe anemia, the frequent occurrence of infections and the need for blood transfusions. Many MDS patients are elderly patients who might present with comorbidities from the time of diagnosis. Our investigation started with a systematic search of the literature in which prospective studies were identified and evaluated according to a predefined coding scheme. Both HRQOL outcomes and traditional clinical reported outcomes were systematically analyzed. Overall, we found nine prospective studies, four of which evaluated HRQOL in a randomized controlled trial setting and, interestingly, all these studies were published after the year 2001, possibly reflecting a recent interest in HRQOL research in MDS patients. While methodological drawbacks were identified, mainly in terms of small sample size and amount of missing data, HROQL assessment has been shown to be feasible in MDS patients and there are excellent examples of how this approach can provide additional key outcomes. A good example is the important evidence emerging from two recent randomized controlled trials that HRQOL benefits are obtained with azacitidine and decitabine compared with supportive care. In view of the enormous potential of patient-reported outcome assessment in providing valuable outcomes in support of clinical decision-making, its implementation in future studies of MDS patients is strongly recommended.
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Affiliation(s)
- Giovanni Caocci
- Cattedra di Ematologia, Centro Trapianti Midollo Osseo, Ospedale R. Binaghi, Via Is Guadazzonis 3, Cagliari, Italy.
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271
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Steensma DP. ASH 2010 meeting report-Top 10 clinically-oriented abstracts in myelodysplastic syndromes (MDS). Am J Hematol 2011. [DOI: 10.1002/ajh.21975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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272
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Flow cytometric scoring system as a diagnostic and prognostic tool in myelodysplastic syndromes. Leuk Res 2011; 35:868-73. [PMID: 21397943 DOI: 10.1016/j.leukres.2011.02.016] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 02/11/2011] [Accepted: 02/14/2011] [Indexed: 11/24/2022]
Abstract
The aim of this study is to validate the clinical utility of the flow cytometric scoring system (FCSS), quantifying phenotypic aberrancies in the myelomonocytic lineages, in the diagnosis and prognosis for conventionally treated myelodysplastic syndromes (MDS) patients. The bone marrow samples from 56 consecutive newly diagnosed MDS patients were characterized by the FCSS and compared with findings in 27 non-MDS cytopenic patients. The FCSS scores were significantly higher in patients with MDS than those in the non-MDS control. A flow score of 2 or more allowed for a specificity of 100% with 75% sensitivity in distinguishing these two groups. The FCSS scores correlated directly with validated prognostic systems including WHO classification, International Prognostic Scoring System (IPSS), WHO-adjusted prognostic scoring system (WPSS) and transfusion dependency. The median survival of conventionally treated MDS patients was directly related to FCSS group; severe: 6 months; moderate: 19 months and normal/mild: not reached. The multivariate analyses suggested the FCSS risk categories were an independent prognostic factor after adjustment for sex, age (above or below 70 years), IPSS or WPSS risk categories. These results confirm that quantifying aberrancies in the myelomonocytic lineage by FCSS is useful in MDS diagnosis and extends the prognostic utility for conventionally treated/untreated patients, especially among patients classified within the refractory cytopenia with multilineage dysplasia (RCMD) subgroup.
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273
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Ossenkoppele GJ, van de Loosdrecht AA, Schuurhuis GJ. Review of the relevance of aberrant antigen expression by flow cytometry in myeloid neoplasms. Br J Haematol 2011; 153:421-36. [PMID: 21385170 DOI: 10.1111/j.1365-2141.2011.08595.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article reviews the use of aberrant antigen expression detected by flow cytometry in the diagnosis and clinical handling of acute myeloid leukaemia (AML) and the myelodysplastic syndromes (MDS). Such aberrancies offer a valuable tool for the proper classification of these myeloid malignancies according the World Health Organization 2008 classification. Aberrant antigen expression by flow cytometry is also important for prognostification. This review supports the view, that minimal residual disease detection methods that make use of such aberrancies should be part of the routine management of AML patients to guide therapy, but also suggests the introduction of flow cytometry in MDS for diagnosis and treatment decisions in the near future.
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Affiliation(s)
- Gert J Ossenkoppele
- Department of Haematology, VU University Medical Center, De Boelelaan 1117, Amsterdam, the Netherlands.
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274
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Ozbalak M, Cetiner M, Bekoz H, Atesoglu EB, Ar C, Salihoglu A, Tuzuner N, Ferhanoglu B. Azacitidine has limited activity in 'real life' patients with MDS and AML: a single centre experience. Hematol Oncol 2011; 30:76-81. [PMID: 21387357 DOI: 10.1002/hon.986] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 02/01/2011] [Accepted: 02/02/2011] [Indexed: 11/11/2022]
Abstract
Myelodysplastic syndrome (MDS) represents a heterogeneous group of potentially malignant diseases of bone-marrow stem cells. Acute myelogenous leukaemia (AML) is an inevitable outcome for many patients with MDS. Azacitidine has been reported to result in comparably higher response rates and improved survival than other treatment strategies. In this retrospective study, we report the results on 25 'real life' patients with MDS, CMML or AML treated with azacitidine between 2005 and 2009. All patients fulfilled the World Health Organization criteria for MDS and AML. No eligibility criteria other than diagnosis were considered. Complete response (CR) rate was observed in three of the 25 'real life' patients (12%) with a median duration of CR of 5 months (4-6 months). Seven patients (28%) had mono- or bi-lineage haematologic improvement and 15 patients (60%) showed neither morphologic nor haematologic response. Among 17 non-AML patients, the median time from onset of Aza-C treatment to AML transformation was 10 months (4-15 months). Overall death rate was 72%. All of the eight AML patients died. The death rate under Aza-C among non-AML patients was 59%. Unlike the results of the clinical trials, our data show that Aza-C has a limited activity in 'real-life' patients with MDS and AML. It is obvious that Aza-C can induce complete or partial responses in a considerable number of MDS patients but responses are usually not durable as we observed in our patients.
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Affiliation(s)
- Murat Ozbalak
- Division of Hematology, Department of Internal Medicine, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
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275
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Pereira A, Nomdedeu M, Aguilar JL, Belkaid M, Carrió A, Cobo F, Costa D, Rozman M, Sanz C, Nomdedeu B. Transfusion intensity, not the cumulative red blood cell transfusion burden, determines the prognosis of patients with myelodysplastic syndrome on chronic transfusion support. Am J Hematol 2011; 86:245-50. [PMID: 21328437 DOI: 10.1002/ajh.21959] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 12/02/2010] [Indexed: 11/10/2022]
Abstract
Transfusion-dependency is associated with poor prognosis in patients with MDS although the causal link for such association is disputed. This study tests thee hypotheses on the association between transfusion burden and prognosis in the MDS: (1) the cumulative transfusion burden is a confounder merely reflecting the time elapsed from diagnosis; (2) it is a surrogate for higher transfusion intensity, which would reflect a more severe disease; and (3) it is the total amount of transfused RBC units that influences on prognosis. We studied 191 transfusion-dependent patients with MDS or chronic myelomonocytic leukemia. Transfusion intensity was calculated at the time of each transfusion as the yearly-equivalent number of RBC units. The main outcome was acute leukemia-free survival from first transfusion. Median transfusion burden was 30 (range: 4-330) RBC units and 112 patients received ≥ 25 units after a median of 9 months from first transfusion. In nested Cox models, having received ≥ 25 RBC units had a significant effect on survival (P < 0.001) that was not abrogated by including follow-up ≥ 9 months as a time-dependent covariate. Including transfusion intensity in the model had a significant effect on leukemia-free survival (P < 0.001) and cancelled the prognostic value of having received ≥ 25 RBC units. In conclusion, transfusion intensity, instead of the cumulative transfusion burden, is the transfusion-related variable really influencing on the prognosis of patients with transfusion-dependent MDS.
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Affiliation(s)
- Arturo Pereira
- Service of Hemotherapy and Hemostasis, Hospital Clínic, Barcelona, Spain.
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276
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Santos FPS, Kantarjian H, Garcia-Manero G, Ravandi F. The search for better prognostic models in myelodysplastic syndromes. Curr Hematol Malig Rep 2011; 6:13-21. [PMID: 21136214 PMCID: PMC4206196 DOI: 10.1007/s11899-010-0070-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Myelodysplastic syndromes (MDS) are a group of heterogeneous bone marrow disorders characterized by a failure of hematopoiesis and an increased propensity for transformation to acute myeloid leukemia. Determining the prognosis of patients with MDS is essential for discerning the best therapy, which can vary from supportive care to allogeneic stem cell transplantation. The most widely used prognostic model in MDS is the International Prognostic Scoring System (IPSS), which estimates survival and risk of transformation to acute myeloid leukemia based on the percentage of blasts, karyotype, and number of cytopenias, but the IPSS has several limitations that preclude more widespread application. Over the past decade, several studies have reported on new prognostic factors for MDS, including transfusion dependency and DNA methylation abnormalities. More recently, two prognostic models for MDS that aim to overcome the limitations of the IPSS have been published. This review focuses on the most recent advances in this field, detailing current prognostic models and the more important risk factors in MDS.
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Affiliation(s)
- Fabio P. S. Santos
- Hematology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Hagop Kantarjian
- Department of Leukemia, University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0428, Houston, TX 77030, USA
| | - Guillermo Garcia-Manero
- Department of Leukemia, University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0428, Houston, TX 77030, USA
| | - Farhad Ravandi
- Department of Leukemia, University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0428, Houston, TX 77030, USA
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277
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Benetatos L, Dasoula A, Hatzimichael E, Syed N, Voukelatou M, Dranitsaris G, Bourantas KL, Crook T. Polo-like kinase 2 (SNK/PLK2) is a novel epigenetically regulated gene in acute myeloid leukemia and myelodysplastic syndromes: genetic and epigenetic interactions. Ann Hematol 2011; 90:1037-45. [PMID: 21340720 DOI: 10.1007/s00277-011-1193-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 02/07/2011] [Indexed: 11/25/2022]
Abstract
Polo-like kinase 2 (SNK/PLK2), a transcriptional target for wild-type p53 and is hypermethylated in a high percentage of multiple myeloma and B cell lymphomas patients. Given these data, we sought to study the methylation status of the specific gene in acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS), and to correlate it with clinical and genetic features. Using methylation-specific PCR MSP, we analyzed the methylation profile of 45 cases of AML and 43 cases of MDS. We also studied the distribution of MTHFR A1298C and MTHFR C677T polymorphisms and FLT3 mutations in AML patients and correlated the results with hypermethylation in the SNK/PLK2 CpG island. The SNK/PLK2 CpG island was hypermethylated in 68.9% and 88.4% of AML and MDS cases, respectively. Cases with hypermethylation had a trend towards more favorable overall survival (OS). There was no association between different MTHFR genotypes and susceptibility to develop AML. SNK/PLK2 hypermethylation combined with the MTHFR AA1298 genotype was associated with a tendency for a better OS. Similarly, patients with SNK/PLK2 hypermethylation combined with the MTHFR CT677 polymorphism had a better OS (HR = 0.34; p = 0.017). SNK/PLK2 methylation associated with unmutated FLT3 cases had a trend for better OS compared to patients with mutated FLT3 gene. SNK/PLK2 is a novel epigenetically regulated gene in AML and MDS, and methylation occurs at high frequency in both diseases. As such, SNK/PLK2 could represent a potential pathogenetic factor, although additional studies are necessary to verify its exact role in disease pathogenesis.
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Affiliation(s)
- Leonidas Benetatos
- Department of Hematology, University Hospital of Ioannina, Niarchos Avenue, 45500 Ioannina, Greece.
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278
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Liu L, Yang L, Mi Y, Wang J, Li J, Zhang Y, Ma X, Qin T, Xu Z, Xiao Z. RAD51 and XRCC3 polymorphisms: impact on the risk and treatment outcomes of de novo inv(16) or t(16;16)/CBFβ-MYH11(+) acute myeloid leukemia. Leuk Res 2011; 35:1020-6. [PMID: 21296419 DOI: 10.1016/j.leukres.2011.01.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Revised: 01/15/2011] [Accepted: 01/18/2011] [Indexed: 10/18/2022]
Abstract
DNA double-strand break repair via homologous recombination (HR) is essential in maintaining genetic integrity, and may modulate susceptibility to the development of acute myeloid leukemia (AML) and influence outcomes of AML. This study was designed to evaluate the effects of polymorphisms in HR repair genes RAD51 and XRCC3 on the risk and treatment outcomes of inv(16)/t(16;16)/CBFβ-MYH11(+) AML. The distribution of polymorphisms in RAD51-G135C and XRCC3-Thr241Met were studied by PCR-RFLP analysis in 625 cases of de novo AML, including 105 cases with inv(16)/t(16;16)/CBFβ-MYH11, 806 family controls and 704 volunteer controls. It was found that the XRCC3-241Met variant significantly increased the risk of the development of the AML with inv(16)/t(16;16) as compared with both the volunteer control (OR=7.22; 95% CI, 4.37-11.91) and the family control (OR=7.99; 95% CI, 5.03-12.69). A retrospective study conducted in 103 inv(16)/t(16;16) AML patients. In multivariate analysis for the potential prognostic factors, the XRCC3-241Met variant significantly reduced disease-free survival (DFS) in complete remission (CR) achieved patients (HR=2.34, 95% CI, 1.32-4.16). These data indicate that the XRCC3-241Met variant may not be only a susceptibility factor to the AML with inv(16)/t(16;16), but also an independent poor-prognostic factor for this AML subtype.
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Affiliation(s)
- Liang Liu
- State Key Laboratory of Experimental Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
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279
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Tsuda JR, Segato R, Barbosa W, Smith MDAC, Payão SLM. Cytogenetic effect of 5-azacytidine in patients with hematological malignancies. Rev Bras Hematol Hemoter 2011; 33:372-6. [PMID: 23049342 PMCID: PMC3415775 DOI: 10.5581/1516-8484.20110101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 08/26/2011] [Indexed: 11/27/2022] Open
Abstract
Background Recently, the importance of cytogenetics has grown in the diagnosis, prognosis and treatment of leukemias and myelodysplastic syndromes. 5-azacytidine is a drug that has well-known cytogenetical effects and is approved in the treatment of myelodysplastic syndromes. To date, no studies have been performed to evaluate the impact of 5-azacytidine on the chromosomes of patients with hematological neoplasias. This study aimed to investigate the effects of 5-azacytidine on chromosomes of patients with different hematological malignancies using G-band analyses to identify possible cytogenetical alterations. Methods The peripheral blood of 18 patients with hematological malignancies and 18 controls was collected in heparinized tubes. 5-azacytidine was added, at a final concentration of 10-5M, to cultures 7 hours prior to harvest. Results Uncoiled centromeric/pericentromeric heterochromatin of chromosomes-1, 9 and 16 occurred more frequently in the patients than in controls. This higher frequency of uncoiled heterochromatin was statistically significant (p-value = 0.004) for chromosome-9. Conversely, we observed that the fragile site at 19q13 was more frequent in controls (p-value = 0.0468). Conclusions The results of this study suggest that satellite sequences, located in the heterochromatin of chromosome-9, are hypomethylated in hematological malignancies. This hypomethylation may contribute to the disease, activating transposable elements and/or promoting genomic instability, enabling the loss of heterozygosity of important tumor suppressor genes. An investigation of the 19q13 region may help to understand whether or not the predominant occurrence of the fragile site at 19q13 in controls is due to hypermethylation of this region.
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280
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Westerman DA, Burbury KL, Gambell P. Flow cytometry in myelodyplastic syndromes. Pathology 2011. [DOI: 10.1016/s0031-3025(16)33158-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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281
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Impact of adjunct cytogenetic abnormalities for prognostic stratification in patients with myelodysplastic syndrome and deletion 5q. Leukemia 2011; 25:110-20. [PMID: 20882045 DOI: 10.1038/leu.2010.231] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This cooperative study assessed prognostic factors for overall survival (OS) and risk of transformation to acute myeloid leukemia (AML) in 541 patients with de novo myelodysplastic syndrome (MDS) and deletion 5q. Additional chromosomal abnormalities were strongly related to different patients' characteristics. In multivariate analysis, the most important predictors of both OS and AML transformation risk were number of chromosomal abnormalities (P<0.001 for both outcomes), platelet count (P<0.001 and P=0.001, respectively) and proportion of bone marrow blasts (P<0.001 and P=0.016, respectively). The number of chromosomal abnormalities defined three risk categories for AML transformation (del(5q), del(5q)+1 and del(5q)+ ≥ 2 abnormalities) and two for OS (one group: del(5q) and del(5q)+1; and del(5q)+ ≥ 2 abnormalities, as the other one); with a median survival time of 58.0 and 6.8 months, respectively. Platelet count (P=0.001) and age (P=0.034) predicted OS in patients with '5q-syndrome'. This study demonstrates the importance of additional chromosomal abnormalities in MDS patients with deletion 5q, challenges the current '5q-syndrome' definition and constitutes a useful reference series to properly analyze the results of clinical trials in these patients.
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282
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Li L, Yang L, Zhang Y, Xu Z, Qin T, Hao Y, Xiao Z. Detoxification and DNA repair genes polymorphisms and susceptibility of primary myelodysplastic syndromes in Chinese population. Leuk Res 2010; 35:762-5. [PMID: 21176850 DOI: 10.1016/j.leukres.2010.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Revised: 10/13/2010] [Accepted: 12/01/2010] [Indexed: 10/18/2022]
Abstract
Molecular epidemiological studies have found new insights into the etiology of myelodysplastic syndromes (MDS). We analyzed the polymorphisms of 5 genes in 275 patients with primary MDS and 354 healthy controls in an attempt to identify candidate genetic risk factors for primary MDS in Chinese Han population. There was no difference in polymorphic variants of GSTM1, NQO1-C609T and XRCC3-C241T between the patients and controls. The homozygous variant C/C of RAD51-G135C was found to increase the susceptibility to MDS (OR, 4.13; p=0.001) and the risk of MDS association with structural abnormal karyotype (OR, 7.67; p=0.001). In addition, the null genotype of GSTT1 was correlated MDS patients with complex aberrant karyotype (OR, 3.25; p=0.012). These potential genetic predisposition suggested their possible involvement in the multistep pathogenesis of MDS.
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Affiliation(s)
- Lin Li
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
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283
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Juopperi TA, Bienzle D, Bernreuter DC, Vernau W, Thrall MA, McManus PM. Prognostic markers for myeloid neoplasms: a comparative review of the literature and goals for future investigation. Vet Pathol 2010; 48:182-97. [PMID: 21139142 DOI: 10.1177/0300985810389317] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Myeloid neoplasms include cancers associated with both rapid (acute myeloid leukemias) and gradual (myelodysplastic syndromes and myeloproliferative neoplasms) disease progression. Percentage of blast cells in marrow is used to separate acute (rapid) from chronic (gradual) and is the most consistently applied prognostic marker in veterinary medicine. However, since there is marked variation in tumor progression within groups, there is a need for more complex schemes to stratify animals into specific risk groups. In people with acute myeloid leukemia (AML), pretreatment karyotyping and molecular genetic analysis have greater utility as prognostic markers than morphologic and immunologic phenotypes. Karyotyping is not available as a prognostic marker for AML in dogs and cats, but progress in molecular genetics has created optimism about the eventual ability of veterinarians to discern conditions potentially responsive to medical intervention. In people with myelodysplastic syndromes (MDS), detailed prognostic scoring systems have been devised that use various combinations of blast cell percentage, hematocrit, platelet counts, unilineal versus multilineal cytopenias and dysplasia, karyotype, gender, age, immunophenotype, transfusion dependence, and colony-forming assays. Predictors of outcome for animals with MDS have been limited to blast cell percentage, anemia versus multilineal cytopenias, and morphologic phenotype. Prognostic markers for myeloproliferative neoplasms (eg, polycythemia vera, essential thrombocythemia) include clinical and hematological factors and in people also include cytogenetics and molecular genetics. Validation of prognostic markers for myeloid neoplasms in animals has been thwarted by the lack of a large case series that requires cooperation across institutions and veterinary specialties. Future progress requires overcoming these barriers.
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Affiliation(s)
- T A Juopperi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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284
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Xu F, Li X, Wu L, Zhang Q, Yang R, Yang Y, Zhang Z, He Q, Chang C. Overexpression of the EZH2, RING1 and BMI1 genes is common in myelodysplastic syndromes: relation to adverse epigenetic alteration and poor prognostic scoring. Ann Hematol 2010; 90:643-53. [PMID: 21125401 DOI: 10.1007/s00277-010-1128-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 11/21/2010] [Indexed: 10/18/2022]
Abstract
Epigenetics refers to the study of clonally inherited changes in gene expression without accompanying genetic changes. Previous research on the epigenetics of myelodysplastic syndromes (MDS) mainly focused on the inactivation of tumor suppressor genes as a result of DNA methylation. However, the basic molecular pathogenesis of epigenetics in MDS remains poorly understood. Recent studies have revealed that DNA methylation and histone modification may be controlled by Polycomb-group (PcG) proteins, which may give new clues toward understanding the epigenetic mechanism of MDS. In this study, we explored for the first time the expression of PcG genes, including EZH2, EED, SUZ12, RING1, and BMI1, in various MDS subsets and acute myeloid leukemia (AML), as well as the relationship between the expression of PcG genes and epigenetic alteration and prognosis-risk scoring. Patients with MDS/AML showed overexpression of EZH2, RING1, and BMI1 genes compared to their expression levels in patients with non-clonal cytopenia diseases. The MDS patients with DNA methylation had higher EZH2 expression than those without DNA methylation. The patients who received decitabine treatment presented significantly reduced expression of EZH2 and RING1 besides decreased p15(INK4B) methylation after decitabine treatment. Moreover, overexpression of EZH2, RING1, and BMI1 was always linked to poor prognostic scoring. In conclusion, overexpression of the EZH2, RING1, and BMI1 genes is common in MDS and indicate poor prognosis. The products of these genes might participate in epigenetic regulation of MDS. These studies may also contribute to our understanding of the effective mechanism of decitabine.
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Affiliation(s)
- Feng Xu
- Department of Hematology, The Sixth people Hospital, Shanghai JiaoTong University, ShangHai Jiaotong University School of Medicine, Shanghai, 200233, People's Republic of China
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285
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Abstract
Sustained clinical cytopenia is a frequent laboratory finding in ambulatory and hospitalized patients. For pathologists and hematopathologists who examine the bone marrow (BM), a diagnosis of cytopenia secondary to an infiltrative BM process or acute leukemia can be readily established based on morphologic evaluation and flow cytometry immunophenotyping. However, it can be more challenging to establish a diagnosis of myelodysplastic syndrome (MDS). In this article, the practical approaches for establishing or excluding a diagnosis of MDS (especially low-grade MDS) in patients with clinical cytopenia are discussed along with the current diagnostic recommendations provided by the World Health Organization and the International Working Group for MDS.
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Affiliation(s)
- Sa A Wang
- Department of Hematopathology, University of Texas, MD Anderson Cancer Center, Unit 72, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA.
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286
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Matarraz S, López A, Barrena S, Fernandez C, Jensen E, Flores-Montero J, Rasillo A, Sayagues JM, Sánchez ML, Bárcena P, Hernandez-Rivas JM, Salvador C, Fernandez-Mosteirín N, Giralt M, Perdiguer L, Laranjeira P, Paiva A, Orfao A. Bone marrow cells from myelodysplastic syndromes show altered immunophenotypic profiles that may contribute to the diagnosis and prognostic stratification of the disease: a pilot study on a series of 56 patients. CYTOMETRY PART B-CLINICAL CYTOMETRY 2010; 78:154-68. [PMID: 20198685 DOI: 10.1002/cyto.b.20513] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED A heterogeneous spectrum of immunophenotypic abnormalities have been reported in myelodysplastic syndromes (MDS). However, most studies are restricted to the analysis of CD34(+) cells and/or other major subsets of CD34(-) cells, frequently not exploring the diagnostic and prognostic impact of immunophenotyping. METHODS We propose for the first time an immunophenotypic score (IS) based on the altered distribution and immunophenotypic features of maturing/mature compartments of bone marrow (BM) hematopoietic cells in 56 patients with MDS that could contribute to a refined diagnosis and prognostic evaluation of the disease. RESULTS Although MDS-associated phenotypes were detected in reactive BM, the overall immunophenotypic profile of BM cells allowed an efficient discrimination between MDS and both normal and reactive BM, once the number and degree of severity of the abnormalities detected per patient were simultaneously considered in the proposed IS. Interestingly, increasingly higher IS were found among patients with MDS showing adverse prognostic factors and in low- versus high-grade cases. The most informative prognostic factors included the number of CD34(+) cells, presence of aberrant CD34(-)/CD117(+) precursors, decreased mature neutrophils and CD34(-) erythroid precursors, and increased numbers of CD36(-/lo) erythroid precursors; in addition, the IS was an independent prognostic factor for overall survival. CONCLUSIONS Assessment of immunophenotypic abnormalities of maturing/mature BM cells allows an efficient discrimination between MDS and both normal and reactive BM, once the number and degree of severity of the abnormalities detected are simultaneously scored. Interestingly, progressively higher IS were found among patients with MDS with adverse prognostic features and shorter overall survival.
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Affiliation(s)
- Sergio Matarraz
- Centro de Investigación del Cáncer (Instituto de Biología Molecular y Celular del Cáncer; CSIC-USAL), Servicio General de Citometría and Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
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287
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Harrington A, Olteanu H, Kroft S. The specificity of immunophenotypic alterations in blasts in nonacute myeloid disorders. Am J Clin Pathol 2010; 134:749-61. [PMID: 20959658 DOI: 10.1309/ajcpfnf5mn1gdwku] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Data regarding flow cytometry (FC) in nonacute myeloid disorders is confounded by variable gating strategies and controls limited to normal bone marrow (BM) samples. Blasts in diagnostic BM samples of myelodysplastic syndromes (MDSs), myeloproliferative neoplasms (MPNs), and chronic myelomonocytic leukemias (CMMLs) were compared with 20 nonneoplastic cytopenias/cytoses (CCs) and negative staging BM samples using 4-color FC. Blasts in 10 of 20 CCs showed immunophenotypic differences vs control samples. Immunophenotypic alterations were identified in 18 of 21 MDSs, 11 of 14 MPNs, and 7 of 7 CMMLs vs control samples and 13 (62%) of 21 MDSs, 7 (50%) of 14 MPNs, and 3 (43%) of 7 CMMLs vs CCs. Neoplastic-specific blast immunophenotypic changes included expression of CD7, CD11b, CD15, CD36, and CD56; CD34 overexpression; HLA-DR variability; lack of CD13 and CD33; underexpression of CD13, CD33, CD45, and HLA-DR; and partial loss of CD13, CD33, CD38, and CD117. In all cases, blasts were CD34+. Several blast immunophenotypic alterations are shared in neoplastic and nonneoplastic BM samples. Approximately 40% to 60% of neoplastic BM samples exhibited aberrancies not seen in reactive BM samples.
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288
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Valent P, Orazi A, Büsche G, Schmitt-Gräff A, George TI, Sotlar K, Streubel B, Beham-Schmid C, Cerny-Reiterer S, Krieger O, van de Loosdrecht A, Kern W, Ogata K, Wimazal F, Csomor J, Várkonyi J, Sperr WR, Werner M, Kreipe H, Hans-Peter H. Standards and impact of hematopathology in myelodysplastic syndromes (MDS). Oncotarget 2010; 1:483-496. [PMID: 21317447 PMCID: PMC3248141 DOI: 10.18632/oncotarget.185] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Accepted: 11/15/2010] [Indexed: 11/25/2022] Open
Abstract
The diagnosis, classification, and prognostication of patients with myelodysplastic syndromes (MDS) are usually based on clinical parameters, analysis of peripheral blood and bone marrow smears, and cytogenetic determinants. However, a thorough histologic and immunohistochemical examination of the bone marrow is often required for a final diagnosis and exact classification in these patients. Notably, histology and immunohistology may reveal dysplasia in megakaryocytes or other bone marrow lineages and/or the presence of clusters of CD34-positive precursor cells. In other cases, histology may reveal an unrelated or co-existing hematopoietic neoplasm, or may support the conclusion the patient is suffering from acute myeloid leukemia rather than MDS. Moreover, histologic investigations and immunohistology may reveal an increase in tryptase-positive cells, a coexisting systemic mastocytosis, or bone marrow fibrosis, which is of prognostic significance. To discuss diagnostic algorithms, terminologies, parameters, and specific issues in the hematopathologic evaluation of MDS, a Working Conference involving a consortium of US and EU experts, was organized in June 2010. The outcomes of the conference and resulting recommendations provided by the faculty, are reported in this article. These guidelines should assist in the diagnosis, classification, and prognostication in MDS in daily practice as well as in clinical trials.
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Affiliation(s)
- Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Austria
- Ludwig Boltzmann Cluster Oncology, Vienna, Austria
| | - Attilio Orazi
- New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Guntram Büsche
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | | | - Tracy I. George
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Karl Sotlar
- Institute of Pathology, University of Munich
| | | | | | - Sabine Cerny-Reiterer
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Austria
| | - Otto Krieger
- First Department of Internal Medicine, Elisabethinen Hospital Linz, Austria
| | | | | | - Kiyoyuki Ogata
- Division of Hematology, Department of Medicine, Nippon Medical School, Tokyo, Japan
| | - Friedrich Wimazal
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Austria
- Department of Obstetrics and Gynaecology, Medical University of Vienna
| | - Judit Csomor
- Institute of Pathology, Semmelweis University, Budapest, Hungary
| | - Judit Várkonyi
- Department of Hematology, Semmelweis University, Budapest, Hungary
| | - Wolfgang R. Sperr
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Austria
| | - Martin Werner
- Department of Pathology, University of Freiburg, Germany
| | - Hans Kreipe
- Institute of Pathology, Hannover Medical School, Hannover, Germany
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289
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Ando K, Tanaka Y, Hashimoto Y, Ohyashiki JH, Sugimori N, Nakao S, Ohyashiki K. correspondence: PNH-phenotype cells in patients with idiopathic cytopenia of undetermined significance (ICUS) with megakaryocytic hypoplasia and thrombocytopenia. Br J Haematol 2010; 150:705-7. [DOI: 10.1111/j.1365-2141.2010.08257.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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290
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Kern W, Haferlach C, Schnittger S, Haferlach T. Clinical utility of multiparameter flow cytometry in the diagnosis of 1013 patients with suspected myelodysplastic syndrome. Cancer 2010; 116:4549-63. [DOI: 10.1002/cncr.25353] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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291
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Lin J, Wang YL, Qian J, Yao DM, Zhu ZH, Qian Z, Xu WR. Aberrant methylation of DNA-damage-inducible transcript 3 promoter is a common event in patients with myelodysplastic syndrome. Leuk Res 2010; 34:991-4. [DOI: 10.1016/j.leukres.2010.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 10/10/2009] [Accepted: 01/05/2010] [Indexed: 01/20/2023]
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292
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Yin CC, Medeiros LJ, Bueso-Ramos CE. Recent advances in the diagnosis and classification of myeloid neoplasms--comments on the 2008 WHO classification. Int J Lab Hematol 2010; 32:461-76. [PMID: 20626469 DOI: 10.1111/j.1751-553x.2010.01246.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The fourth edition of the World Health Organization (WHO) classification of myeloid neoplasms refined the criteria for some previously described myeloid neoplasms and recognized several new entities based on recent elucidation of molecular pathogenesis, identification of new diagnostic and prognostic markers, and progress in clinical management. Protein tyrosine kinase abnormalities, including translocations or mutations involving ABL1, JAK2, MPL, KIT, PDGFRA, PDGFRB, and FGFR1, have been used as the basis for classifying myeloproliferative neoplasms (MPN). Two new entities - refractory cytopenia with unilineage dysplasia and refractory cytopenia of childhood have been added to the group of myelodysplastic syndromes (MDS), and 'refractory anemia with excess blasts-1' has been redefined to emphasize the prognostic significance of increased blasts in the peripheral blood. A list of cytogenetic abnormalities has been introduced as presumptive evidence of MDS in cases with refractory cytopenia but without morphologic evidence of dysplasia. The subgroup 'acute myeloid leukemia (AML) with recurrent genetic abnormalities' has been expanded to include more molecular genetic aberrations. The entity 'AML with multilineage dysplasia' specified in the 2001 WHO classification has been renamed 'AML with myelodysplasia-related changes' to include not only cases with significant multilineage dysplasia but also patients with a history of MDS or myelodysplasia-related cytogenetic abnormalities. The term 'therapy-related myeloid neoplasms' is used to cover the spectrum of disorders previously known as t-AML, t-MDS, or t-MDS/MPN occurring as complications of cytotoxic chemotherapy and/or radiation therapy. In this review, we summarize many of these important changes and discuss some of the diagnostic challenges that remain.
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Affiliation(s)
- C C Yin
- The Department of Hematopathology, UT MD Anderson Cancer Center, Houston, TX 77030, USA.
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293
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Komrokji RS, Zhang L, Bennett JM. Myelodysplastic syndromes classification and risk stratification. Hematol Oncol Clin North Am 2010; 24:443-57. [PMID: 20359636 DOI: 10.1016/j.hoc.2010.02.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Myelodysplastic syndromes (MDS) are spectrum of bone marrow failure disorders that share a common pathologic feature: cytologic dysplasia. The classification of MDS reflects the understanding of the disease. It is hoped that in the future classification and risk stratification will be based on underlying pathobiology of different disease subsets and molecular signatures where the pathologic classification represents their phenotype. This article reviews MDS classification and risk stratification highlighting differences between the various systems.
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Affiliation(s)
- Rami S Komrokji
- H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA.
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294
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Abstract
The myelodysplastic syndromes (MDS) are a heterogeneous spectrum of disorders requiring selective therapy based on patients' specific clinical features, predominantly their prognostic subgroups, age and performance status. Guidelines for management of patients with MDS have been generated by a number of national panels. This review focuses on evidence-based data supporting therapeutic approaches, which have also been recommended by the US National Comprehensive Cancer Network MDS Panel, with discussion of accessibility of recommended drugs in the US and in other countries. For lower risk disease (International Prognostic Scoring System Low and Intermediate-1) therapy is aimed at haematological improvement whereas for higher risk disease (Intermediate-2 and High) treatment focuses on altering disease natural history. Recent information regarding additional clinical and biological features has provided useful parameters for assessing disease prognosis that aid risk-based management decisions. The rationale for use of low versus high intensity therapies with these agents, including allogeneic haematopoietic stem cell transplantation, is discussed in detail.
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Affiliation(s)
- Peter L Greenberg
- Hematology Division, Stanford University Cancer Center, Stanford, CA 94305-5821, USA.
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295
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Schroeder T, Ruf L, Bernhardt A, Hildebrandt B, Aivado M, Aul C, Gattermann N, Haas R, Germing U. Distinguishing myelodysplastic syndromes (MDS) from idiopathic cytopenia of undetermined significance (ICUS): HUMARA unravels clonality in a subgroup of patients. Ann Oncol 2010; 21:2267-2271. [PMID: 20439346 DOI: 10.1093/annonc/mdq233] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Patients not fulfilling minimal criteria for myelodysplastic syndromes (MDS) but presenting with persisting cytopenia(s) not attributable to a haematological or non-haematological disease are defined as 'idiopathic cytopenia of undetermined significance' (ICUS). DESIGN AND METHODS We retrospectively analysed 67 of 3504 patients from our MDS Registry fulfilling the criteria for ICUS. Furthermore, we used the human androgen receptor gene-based assay (HUMARA) to look for clonality. RESULTS Of all 67 patients, 66% had unilineage, 18% bilineage and 12% trilineage cytopenias. The majority of patients (67%) presented with anaemia. Median overall survival was 44 months (range: 1-199 months). In the entire group, eight patients (12%) developed acute myeloid leukaemia (AML). Of the 23 patients eligible for HUMARA, 17 had non-clonal X-chromosome inactivation patterns, while 6 patients showed clonal patterns. Two of these six patients developed AML indicating that a clonal stem cell disorder was the reason for the anteceding cytopenia, while there was no AML observed among the 17 patients with non-clonal patterns (P = 0.013). CONCLUSIONS Since some of the ICUS patients had a clonal bone marrow disease when presenting with cytopenia(s) and 8 of 67 patients with ICUS later developed AML, we recommend to follow these patients thoroughly. As demonstrated here, HUMARA can facilitate the discrimination between ICUS and a 'manifest' MDS.
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Affiliation(s)
- T Schroeder
- Department of Haematology, Oncology and Clinical Immunology.
| | - L Ruf
- Department of Haematology, Oncology and Clinical Immunology
| | - A Bernhardt
- Department of Haematology, Oncology and Clinical Immunology
| | - B Hildebrandt
- Institute of Human Genetics and Anthropology, Heinrich-Heine University, Düsseldorf, Germany
| | - M Aivado
- Department of Haematology, Oncology and Clinical Immunology; Global Clinical Development Oncology GlaxoSmithKline, Collegeville, PA, USA
| | - C Aul
- Department of Haematology, Oncology and Clinical Immunology, St Johannes Hospital, Duisburg, Germany
| | - N Gattermann
- Department of Haematology, Oncology and Clinical Immunology
| | - R Haas
- Department of Haematology, Oncology and Clinical Immunology
| | - U Germing
- Department of Haematology, Oncology and Clinical Immunology
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296
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Adding FISH to karyotype in Myelodysplastic syndrome investigation diagnosis: Are all questions answered? Leuk Res 2010; 34:413-5. [DOI: 10.1016/j.leukres.2009.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 10/09/2009] [Accepted: 10/11/2009] [Indexed: 11/23/2022]
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297
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Predictive value of pretreatment risk group and baseline LDH levels in MDS patients receiving azacitidine treatment. Ann Hematol 2010; 89:681-9. [DOI: 10.1007/s00277-010-0921-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 02/02/2010] [Indexed: 10/19/2022]
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298
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Xu F, Li X, Wu L, He Q, Zhang Z, Chang C. Flow cytometric scoring system (FCMSS) assisted diagnosis of myelodysplastic syndromes (MDS) and the biological significance of FCMSS-based immunophenotypes. Br J Haematol 2010; 149:587-97. [PMID: 20331463 DOI: 10.1111/j.1365-2141.2010.08146.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In the myelodysplastic syndromes (MDS), the haematopoietic cells show various levels of abnormal maturation and differentiation, which can be detected by flow cytometry. Testing the anomalies of stage- or lineage-specific surface antigens in CD34+ blasts can distinguish MDS from non-clonal cytopenic diseases, and also reflect the pathological characteristics of MDS as a class of clonal diseases for providing new clues to basic research. The present study established a flow cytometric scoring system (FCMSS) based on theproportion and antigenic co-expression of CD34+ blasts. This FCMSS showed good sensitivity and specificity (77.8% and 100%) in the assisted diagnosis of low-risk MDS without chromosome anomalies, ringed sideroblasts and excess marrow blasts. Moreover, we explored and reported different modes of abnormal expression of CD34+ blasts antigens in different disease stages and analyzed the biological significance of the immunotypes for the first time. We found expression of mature myeloid antigens and lymphoid antigens gradually decreased, and early functional antigens gradually increased from low-risk MDS with normal karytype to low-risk MDS with abnormal karyotype then to high-risk MDS. The patients with higher FCM scores were generally accompanied with HLA-DR15 allele or hypocellular marrow. Evolution of clones and immunological factors might have influence on expression of antigens in CD34+ blasts.
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Affiliation(s)
- Feng Xu
- Department of Haematology, Sixth Hospital affiliated to Shanghai Jiaotong University, Shanghai, China
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299
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Benetatos L, Hatzimichael E, Dasoula A, Dranitsaris G, Tsiara S, Syrrou M, Georgiou I, Bourantas KL. CpG methylation analysis of the MEG3 and SNRPN imprinted genes in acute myeloid leukemia and myelodysplastic syndromes. Leuk Res 2010; 34:148-53. [PMID: 19595458 DOI: 10.1016/j.leukres.2009.06.019] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Revised: 06/12/2009] [Accepted: 06/15/2009] [Indexed: 11/25/2022]
Abstract
Methylation is now established as a fundamental regulator of gene transcription. To investigate this in haematologic malignancies, we evaluated the aberrant promoter methylation of two imprinted genes (MEG3 and SNRPN) in 43 MDS and 42 AML patients. MEG3 hypermethylation occurred in 15 MDS patients (34.9%), and in 20 AML patients (47.6%). SNRPN hypermethylation was observed in 15 MDS patients (34.9%), and in 21 AML patients (50%). There were no significant correlations between WHO subtype, WPSS score, karyotype, haemoglobin levels, white blood cell count, platelet count and CpG methylation of any gene. MEG3 hypermethylation was associated with significantly reduced overall survival in individuals with AML (HR=1.98, p=0.04), while SNRPN CpG methylation was not associated with survival (HR=0.94, p=0.87). In addition, no association between survival and aberrant MEG3 (HR=2.15, p=0.072) or SNRPN methylation (HR=1.08, p=0.85) was observed in patients MDS. Our findings suggest that these genes are abnormally methylated in AML and MDS patients, and methylation of MEG3 confers worse overall prognosis. The MEG3 methylation status may serve as a useful biomarker in leukemia.
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Affiliation(s)
- Leonidas Benetatos
- Department of Hematology, University Hospital of Ioannina, Niarchos Avenue, 45500 Ioannina, Greece.
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300
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Does cytogenetic evolution have any prognostic relevance in myelodysplastic syndromes? A study on 153 patients from a single institution. Ann Hematol 2010; 89:545-51. [PMID: 20217086 DOI: 10.1007/s00277-010-0927-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 02/11/2010] [Indexed: 10/19/2022]
Abstract
The present study was designed to establish the incidence of cytogenetic evolution (CE), defined as the acquisition of chromosomal defects during the course of MDS, in order to correlate it with the WHO classification and IPSS score, and to assess its impact on overall survival (OS) and risk of MDS/AML evolution (progression-free interval, PFI) by means of Cox models for time-dependent covariates. Adjustments for known risk factors were achieved by performing a bivariable analysis. The study was carried out in 153 MDS patients who were followed for a median period of 45.2 months. Disease progression occurred in 42.4% of patients after a 65.2-month median PFI, while CE occurred in 30.7% of patients. Our study shows that (1) CE was more common in advanced than in early MDS, and advanced MDS presented secondary chromosomal defects distinct from those of early MDS; (2) CE significantly affected OS and PFI independently of other prognostic variables; (3) del(7)(q31q34) was the only secondary chromosomal defect which significantly affected PFI; trisomy 8 had only a moderate influence.
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