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Yuen LD, Hasserjian RP. Morphologic Characteristics of Myelodysplastic Syndromes. Clin Lab Med 2023; 43:577-596. [PMID: 37865504 DOI: 10.1016/j.cll.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Morphologic characterization remains a cornerstone in the diagnosis and classification of myelodysplastic syndromes (MDS) in the updated International Consensus Classification (ICC) and 5th edition World Health Organization Classification of Myeloid Neoplasms (Arber, Orazi, & Hasserjian, 2022; Khoury & Solary, 2022). The presence of dysplasia is one of the key diagnostic criteria required for establishing a diagnosis of MDS, and the percentage of myeloblasts in the blood and bone marrow impacts both disease classification and prognostication. Morphologic features also aid in distinguishing MDS from a myriad of other myeloid neoplasms and non-neoplastic mimics. Additional key morphologic features that should be recorded in any MDS case are the bone marrow cellularity and the degree of reticulin fibrosis. In this review, the morphologic assessment of the bone marrow biopsy, bone marrow aspirate, and peripheral blood smear as it pertains to the diagnosis and up-to-date classification of MDS will be described. The implications of the findings on classification and prognosis will also be discussed.
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Affiliation(s)
- Lisa D Yuen
- Department of Pathology-WRN 244, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Robert P Hasserjian
- Department of Pathology-WRN 244, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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2
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Wagner-Ballon O, Kosmider O. [MDS & CMML: Diagnostic and classification]. Bull Cancer 2023; 110:1106-1115. [PMID: 37453834 DOI: 10.1016/j.bulcan.2023.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 07/18/2023]
Abstract
In 2023, a diagnosis process of myelodysplastic syndrome (MDS) or chronic myelomonocytic leukemia (CMML) is mainly based on morphological results obtained on bone marrow and blood smears which could be completed by cytogenetical analyses. Due to recent finding, flow cytometry data are recognized as useful for the diagnosis of CMML especially. Actual classifications and prognostic scoring systems have changed and nowadays include results of high-throughput sequencing approaches in addition to cytogenetical results. All together, these data allow the medical world to correctly evaluate the prognosis of these patients and to provide some information for targeted therapies. This chapter will provide the most important modifications recently published in the field of diagnosis and prognosis of MDS and CMML.
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Affiliation(s)
- Orianne Wagner-Ballon
- Université Paris Est Créteil, Inserm, IMRB, 94010 Créteil, France; AP-HP, hôpital Henri-Mondor, département d'hématologie et immunologie, 94010 Créteil, France
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3
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Barone P, Patel S. Myelodysplastic syndrome: Approach to diagnosis in the era of personalized medicine. Semin Diagn Pathol 2023; 40:172-181. [PMID: 37121781 DOI: 10.1053/j.semdp.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Paul Barone
- NewYork-Presbyterian Hospital, Weill Cornell Campus, United States of America.
| | - Sanjay Patel
- Weill Cornell Medicine, United States of America
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4
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Sun P, Li N, Zhang S, Liu S, Zhang H, Yue B. Combination of NeuX and NeuZ can predict neutrophil dysplasia features of myelodysplastic neoplasms in peripheral blood. Int J Lab Hematol 2023. [PMID: 36922282 DOI: 10.1111/ijlh.14057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION The assessment of neutrophil dysplasia features in peripheral blood is very helpful for the early screening and diagnosis of myelodysplastic neoplasms (MDS). Cell population data (CPD) parameters generated by automated hematology analyzers can reflect morphological characteristics of blood cells. This study aimed to investigate the clinical significance of CPD parameters neutrophil (Neu) X, NeuY and NeuZ in assessing neutrophil dysplasia. METHODS 218 MDS patients were divided into two subgroups according to neutrophil morphology. The differences of neutrophil research parameters between the two MDS subgroups and the control group, consisting of 210 healthy individuals, were compared, the correlation among neutrophil research parameters and the relationship between these parameters and cell morphology in MDS patients were analyzed, and receiver operating characteristic analysis were performed. RESULTS The median values of neutrophil research parameters NeuX and NeuZ in MDS with granulocyte dysplasia group were significantly lower than those in MDS without granulocyte dysplasia group and control group (p < 0.001), and they were positively correlated (r = 0.878, p < 0.001). The area under the receiver operating characteristic curve of NeuX and NeuZ was 0.720 (95% CI: 0.643-0.796, p < 0.001) and 0.738 (95% CI: 0.665-0.811, p < 0.001), respectively. In addition, with the decrease of NeuX value, neutrophils gradually show decreased nuclear segment and/or cytoplasmic granules. CONCLUSIONS Combining NeuX and NeuZ can predict neutrophil dysplasia features of MDS in peripheral blood, and this can be an easier method to screen for the neutrophil dysplasia cases, as compared with the microscopic examination of peripheral blood and/or bone marrow smears.
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Affiliation(s)
- Pingping Sun
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Clinical Laboratory of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Nan Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Clinical Laboratory of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shijie Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Clinical Laboratory of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuai Liu
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Clinical Laboratory of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huihui Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Clinical Laboratory of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Baohong Yue
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Clinical Laboratory of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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5
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Zini G, Barbagallo O, Scavone F, Béné MC. Digital morphology in hematology diagnosis and education: The experience of the European LeukemiaNet WP10. Int J Lab Hematol 2022; 44 Suppl 1:37-44. [PMID: 36074713 DOI: 10.1111/ijlh.13908] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/19/2022] [Indexed: 11/28/2022]
Abstract
Hematological diagnostics is based on increasingly precise techniques of cellular and molecular analysis. The correct interpretation of the blood and bone marrow smears observed under an optical microscope still represents a cornerstone. Precise quantitative and qualitative cytomorphological criteria have recently been codified by up-to-date guidelines for diagnosing hematopoietic neoplasms. Morphological analysis has found formidable support in digital reproduction techniques, which have simplified the circulation of images for educational or consultation purposes. From 2007 to 2019, the Working Group WP10 of European LeukemiaNet (ELN) used, in annual exercises, digital images to support training in cytomorphology and verify harmonization and comparability in the interpretation of blood and bone marrow smears. We describe the design, development, and results of this program, which had 741 participants in-person or remotely, to which 2055 questions were submitted regarding the interpretation of cytomorphological images. We initially used circulation and presentation of digital microphotographs and then introduced a virtual microscopy (VM). Virtual slides were obtained using a whole slide imaging technique, similar to the one largely used in histopathology, to produce digitized scans of consecutive microscopic fields and reassembles them to obtain a complete virtual smear by stitching. Participants were required to identify cells in labeled fields of view of the virtual slides to obtain a morphological diagnosis. This work has demonstrated substantial improvements in diagnostic accuracy and harmonization with the VM technique. Between-observer concordance increased from 62.5% to 83.0%. The integrity of the digitalized film image, which provides a general context for cell abnormalities, was the main factor for this outcome.
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Affiliation(s)
- Gina Zini
- Hematology, Catholic University of Sacred Heart, Rome, Italy.,Transfusion Service, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ombretta Barbagallo
- Transfusion Service, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Fernando Scavone
- Transfusion Service, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marie C Béné
- Hematology Biology, Nantes University Hospital and CRCINA, Nantes, France
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Prospective comparison of 5- and 7-day administration of azacitidine for myelodysplastic syndromes: a JALSG MDS212 trial. Int J Hematol 2022; 116:228-238. [PMID: 35508695 DOI: 10.1007/s12185-022-03347-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
The hypomethylating agent azacitidine (AZA) significantly extends overall survival (OS) in patients with higher risk myelodysplastic syndromes (MDS), when compared with other conventional care regimens, including supportive care and low-dose and intensive chemotherapy. However, the effects of 5- and 7-day treatment schedules of AZA (AZA-5 and AZA-7, respectively) on the OS of MDS patients had not been compared prospectively. We started a phase 3 trial comparing the effects of AZA-7 and AZA-5 on MDS patients with refractory anemia with excess blasts (RAEB) and RAEB in transformation (RAEB-T). However, this trial was prematurely terminated because of poor recruitment. Using all data, there was no significant difference in the OS of patients between AZA-7 (92 patients) and AZA-5 (95 patients), with the 2-year OS rates of AZA-7 and AZA-5 at 36.4% and 25.8%, respectively (P = 0.293). Adverse event profiles were similar between the two groups. Interestingly, data of the centrally diagnosed RAEB and RAEB-T cases showed that AZA-7 significantly prolonged the time to leukemia transformation compared with AZA-5 (P = 0.022), confirmed by multivariate analysis. Although this trial could not provide definite evidence, the results support the use of AZA-7 for RAEB and RAEB-T. (UMIN Clinical Trials Registry UMIN000009633).
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7
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Duchmann M, Wagner-Ballon O, Boyer T, Cheok M, Fournier E, Guerin E, Fenwarth L, Badaoui B, Freynet N, Benayoun E, Lusina D, Garcia I, Gardin C, Fenaux P, Pautas C, Quesnel B, Turlure P, Terré C, Thomas X, Lambert J, Renneville A, Preudhomme C, Dombret H, Itzykson R, Cluzeau T. Machine learning identifies the independent role of dysplasia in the prediction of response to chemotherapy in AML. Leukemia 2022; 36:656-663. [PMID: 34615986 DOI: 10.1038/s41375-021-01435-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 12/17/2022]
Abstract
The independent prognostic impact of specific dysplastic features in acute myeloid leukemia (AML) remains controversial and may vary between genomic subtypes. We apply a machine learning framework to dissect the relative contribution of centrally reviewed dysplastic features and oncogenetics in 190 patients with de novo AML treated in ALFA clinical trials. One hundred and thirty-five (71%) patients achieved complete response after the first induction course (CR). Dysgranulopoiesis, dyserythropoiesis and dysmegakaryopoiesis were assessable in 84%, 83% and 63% patients, respectively. Multi-lineage dysplasia was present in 27% of assessable patients. Micromegakaryocytes (q = 0.01), hypolobulated megakaryocytes (q = 0.08) and hyposegmented granulocytes (q = 0.08) were associated with higher ELN-2017 risk. Using a supervised learning algorithm, the relative importance of morphological variables (34%) for the prediction of CR was higher than demographic (5%), clinical (2%), cytogenetic (25%), molecular (29%), and treatment (5%) variables. Though dysplasias had limited predictive impact on survival, a multivariate logistic regression identified the presence of hypolobulated megakaryocytes (p = 0.014) and micromegakaryocytes (p = 0.035) as predicting lower CR rates, independently of monosomy 7 (p = 0.013), TP53 (p = 0.004), and NPM1 mutations (p = 0.025). Assessment of these specific dysmegakarypoiesis traits, for which we identify a transcriptomic signature, may thus guide treatment allocation in AML.
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Affiliation(s)
- Matthieu Duchmann
- Laboratoire d'Hématologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.,Université de Paris, Génomes, biologie cellulaire et thérapeutique U944, INSERM, CNRS, 75010, Paris, France
| | - Orianne Wagner-Ballon
- Département d'Hématologie et Immunologie biologiques, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.,INSERM U955 IMRB, UPEC, Créteil, France
| | - Thomas Boyer
- Service d'Hématologie Biologique, CHU Lille, Lille, France.,Service d'Hématologie Biologique, CHU Amiens-Picardie, Amiens, France
| | | | - Elise Fournier
- Service d'Hématologie Biologique, CHU Lille, Lille, France
| | - Estelle Guerin
- Service d'Hématologie biologique, Hôpital Dupuytren, Limoges, France.,UMR CNRS 7276/INSERM 1262, CHU Limoges, Limoges, France
| | - Laurène Fenwarth
- Université Lille, CNRS, INSERM, CHU Lille, IRCL, UMR9020 - UMR1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, 59000, Lille, France
| | - Bouchra Badaoui
- Département d'Hématologie et Immunologie biologiques, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Nicolas Freynet
- Département d'Hématologie et Immunologie biologiques, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Emmanuel Benayoun
- Département d'Hématologie et Immunologie biologiques, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Daniel Lusina
- Laboratoire d'Hématologie, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Université Sorbonne Paris Cité, Bobigny, France
| | - Isabel Garcia
- Laboratoire d'Hématologie, Hôpital André Mignot, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Claude Gardin
- Département d'Hématologie Clinique, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Pierre Fenaux
- Département d'Hématologie Clinique, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Cécile Pautas
- Département d'Hématologie clinique, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Bruno Quesnel
- CHU Lille, Service des Maladies du Sang, 59000, Lille, France
| | - Pascal Turlure
- Département d'Hématologie Clinique, CHU Limoges, Limoges, France
| | - Christine Terré
- Laboratoire de Cytogénétique, Hôpital André Mignot, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Xavier Thomas
- Département d'Hématologie Clinique, Hospices Civils de Lyon, Hôpital Lyon-Sud, Pierre Bénite, France
| | - Juliette Lambert
- Département d'Hématologie Clinique, Hôpital André Mignot, Centre Hospitalier de Versailles, Le Chesnay, France
| | | | - Claude Preudhomme
- Université Lille, CNRS, INSERM, CHU Lille, IRCL, UMR9020 - UMR1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, 59000, Lille, France
| | - Hervé Dombret
- Département d'Hématologie Clinique, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, EA-3518, Institut de Recherche Saint-Louis, Université de Paris, Paris, France
| | - Raphael Itzykson
- Université de Paris, Génomes, biologie cellulaire et thérapeutique U944, INSERM, CNRS, 75010, Paris, France. .,Département d'Hématologie Clinique, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.
| | - Thomas Cluzeau
- Département d'Hématologie, Université Côte d'Azur, CHU de Nice, Nice, France.
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8
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Barros Pinto MP, Marques G, Cristino JM. Not only but also: macropolycytes in sepsis by Serratia marcescens. Hematol Transfus Cell Ther 2021; 44:614-615. [PMID: 34565714 PMCID: PMC9605903 DOI: 10.1016/j.htct.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/30/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
| | - Guilhermina Marques
- Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - J Melo Cristino
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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9
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Shekhar R, Srinivasan VK, Pai S. How I investigate dysgranulopoiesis. Int J Lab Hematol 2021; 43:538-546. [PMID: 34031992 DOI: 10.1111/ijlh.13607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/23/2021] [Accepted: 04/30/2021] [Indexed: 12/23/2022]
Abstract
Dysgranulopoiesis is a condition in which granulocytic production is defective and is most often described in neoplastic conditions. However, it can also be frequently seen in non-neoplastic conditions. Early suspicion and detection of these non-neoplastic causes may prevent further invasive and expensive interventions. In this review, we take a look at the various causes of dysgranulopoiesis with an emphasis on non-neoplastic etiologies, followed by a detailed outline of the laboratory approach for determining its many causes.
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Affiliation(s)
- Roshini Shekhar
- Department of Laboratory Medicine, Manipal Hospital, Bengaluru, Karnataka, India
| | - Vishrut K Srinivasan
- Department of Laboratory Medicine, Manipal Hospital, Bengaluru, Karnataka, India
| | - Swati Pai
- Department of Laboratory Medicine, Manipal Hospital, Bengaluru, Karnataka, India
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10
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Acevedo A, Merino A, Boldú L, Molina Á, Alférez S, Rodellar J. A new convolutional neural network predictive model for the automatic recognition of hypogranulated neutrophils in myelodysplastic syndromes. Comput Biol Med 2021; 134:104479. [PMID: 34010795 DOI: 10.1016/j.compbiomed.2021.104479] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 04/22/2021] [Accepted: 05/06/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Dysplastic neutrophils commonly show at least 2/3 reduction of the content of cytoplasmic granules by morphologic examination. Recognition of less granulated dysplastic neutrophils by human eyes is difficult and prone to inter-observer variability. To tackle this problem, we proposed a new deep learning model (DysplasiaNet) able to automatically recognize the presence of hypogranulated dysplastic neutrophils in peripheral blood. METHODS Eight models were generated by varying convolutional blocks, number of layer nodes and fully connected layers. Each model was trained for 20 epochs. The five most accurate models were selected for a second stage, being trained again from scratch for 100 epochs. After training, cut-off values were calculated for a granularity score that discerns between normal and dysplastic neutrophils. Furthermore, a threshold value was obtained to quantify the minimum proportion of dysplastic neutrophils in the smear to consider that the patient might have a myelodysplastic syndrome (MDS). The final selected model was the one with the highest accuracy (95.5%). RESULTS We performed a final proof of concept with new patients not involved in previous steps. We reported 95.5% sensitivity, 94.3% specificity, 94% precision, and a global accuracy of 94.85%. CONCLUSIONS The primary contribution of this work is a predictive model for the automatic recognition in an objective way of hypogranulated neutrophils in peripheral blood smears. We envision the utility of the model implemented as an evaluation tool for MDS diagnosis integrated in the clinical laboratory workflow.
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Affiliation(s)
- Andrea Acevedo
- Haematology and Cytology Unit, Core Laboratory, Biochemical and Molecular Genetics Department, CDB. Hospital Clínic of Barcelona-IDIBAPS, Barcelona, Spain; Department of Mathematics, Technical University of Catalonia, Barcelona East Engineering School, Barcelona, Spain
| | - Anna Merino
- Haematology and Cytology Unit, Core Laboratory, Biochemical and Molecular Genetics Department, CDB. Hospital Clínic of Barcelona-IDIBAPS, Barcelona, Spain.
| | - Laura Boldú
- Haematology and Cytology Unit, Core Laboratory, Biochemical and Molecular Genetics Department, CDB. Hospital Clínic of Barcelona-IDIBAPS, Barcelona, Spain
| | - Ángel Molina
- Haematology and Cytology Unit, Core Laboratory, Biochemical and Molecular Genetics Department, CDB. Hospital Clínic of Barcelona-IDIBAPS, Barcelona, Spain
| | - Santiago Alférez
- Department of Applied Mathematics and Computer Science, Universidad del Rosario, Bogotá, Colombia
| | - José Rodellar
- Department of Mathematics, Technical University of Catalonia, Barcelona East Engineering School, Barcelona, Spain
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11
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Tizhoosh HR, Diamandis P, Campbell CJV, Safarpoor A, Kalra S, Maleki D, Riasatian A, Babaie M. Searching Images for Consensus: Can AI Remove Observer Variability in Pathology? THE AMERICAN JOURNAL OF PATHOLOGY 2021; 191:1702-1708. [PMID: 33636179 DOI: 10.1016/j.ajpath.2021.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/05/2021] [Accepted: 01/25/2021] [Indexed: 02/07/2023]
Abstract
One of the major obstacles in reaching diagnostic consensus is observer variability. With the recent success of artificial intelligence, particularly the deep networks, the question emerges as to whether the fundamental challenge of diagnostic imaging can now be resolved. This article briefly reviews the problem and how eventually both supervised and unsupervised AI technologies could help to overcome it.
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Affiliation(s)
| | - Phedias Diamandis
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Clinton J V Campbell
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Amir Safarpoor
- Kimia Laboratory, University of Waterloo, Waterloo, Canada
| | - Shivam Kalra
- Kimia Laboratory, University of Waterloo, Waterloo, Canada
| | - Danial Maleki
- Kimia Laboratory, University of Waterloo, Waterloo, Canada
| | | | - Morteza Babaie
- Kimia Laboratory, University of Waterloo, Waterloo, Canada
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12
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AlMozain N, Mashi A, Alneami Q, Al-Omran A, Bakshi N, Owaidah T, Khalil S, Khogeer H, Hashmi S, Al-Sweedan S, Morris T, AlNounou R. Spectrum of myelodysplastic syndrome in patients evaluated for cytopenia(s). A Report from a Reference Centre in Saudi Arabia. Hematol Oncol Stem Cell Ther 2020; 15:39-44. [PMID: 33227261 DOI: 10.1016/j.hemonc.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/03/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/OBJECTIVE Myelodysplastic syndrome (MDS) is a clonal disorder of hematopoietic stem cells, characterized by ineffective hematopoiesis, peripheral cytopenias along with hypercellularity of the bone marrow, and marked dysplastic features. Establishing MDS diagnosis is difficult due to nonspecific clinical presentation and imprecise morphological criteria. In anticipation to improve the diagnostic approach in this field, we aimed to characterize the clinical and morphological features of patients presented with cytopenias with a special focus on MDS. METHODS We comprehensively reviewed all medical record of patients who were referred to the hematology laboratory at KFSH-RC, Riyadh, Saudi Arabia, between January 2009 and March 2016 for evaluation of bone marrow aspirates and trephine biopsies due to severe and persistent cytopenia(s) to rule out MDS. RESULTS A total of 183 patients, 155 adult and 28 pediatric, were identified. In the adult group, MDS was diagnosed in 82 (52.9%) patients, with a male-to-female (M:F) ratio of 1.6:1 and mean age at diagnosis of 50 years. According to the World Health Organization (WHO) 2017 criteria, MDS subtypes were as follows: MDS with single lineage dysplasia (SLD, 5%), MDS with ring sideroblasts and SLD (MDS-RS-SLD 7%), MDS with multilineage dysplasia (MDS-MLD 21%), MDS with deletion of chromosome 5q (MDS del(5q), 2%), MDS unclassifiable (MDS-U7%), hypoplastic MDS (h-MDS 4%), MDS with excess blasts-1 (MDS-EB1, 20%), MDS with excess blasts-2 (MDS- EB2, 28%), and therapy-related MDS (6%). Laboratory and morphological features were described. In both groups, cytogenetic abnormalities were classified according to the Revised International Prognostic Scoring System cytogenetic risk groups. In adults, the dominating cytogenetic abnormalities were monosomy 5 and monosomy 7 seen in 20.7% and 24.4% of patients, respectively. Peripheral cytopenia not due to MDS was diagnosed in 54 (34.8%) patients, with a mean age of 43 years and M:F ratio of 1:1. The cause of these cytopenias were as follows: bone marrow failure (BMF, 22%), peripheral destruction (20%), drug induced (20%), anemia of chronic disease (16%), B12 deficiency (7%), infection (7%), paroxysmal nocturnal hemoglobinuria (4%), idiopathic cytopenia of undetermined significance (2%), and idiopathic dysplasia of undetermined significance (2%). A definite diagnosis of MDS was not possible in 19 patients due to insufficient clinical data. In the pediatric group, MDS was diagnosed in 14/28 (50%) patients, with M:F ratio of 1.8:1 and mean age at diagnosis of 4 years. MDS subtypes (WHO 2017) in 14 patients were as follows: refractory cytopenia of childhood (RCC, 42.8%), MDS-EB1 (42.8%), and MDS-EB2 (14.2%). Laboratory and morphological features were described. The prevalent cytogenetic abnormality was monosomy 7 in six/14 (42.8%) patients. Cytopenias due to other causes were diagnosed in eight/28 patients (28.5%), with a mean age of 6.5 years and M:F ratio of 1.6:1. The causes of non-MDS related cytopenia were: congenital BMF (4 patients), peripheral destruction (2 patients), immune deficiency (1 patient), and viral infection (1 patient). A definite diagnosis of MDS could not be made in six/28 (21.4%) patients. CONCLUSION MDS is the cause of cytopenia in a significant number of patients referred for evaluation of cytopenias, appears at younger age, and tends to be more aggressive than that reported in international studies. Anemia, dysplastic neutrophils in the peripheral blood, and dysplastic megakaryocytes in the bone marrow trephine biopsy are the most reliable features in distinguishing MDS from other alternative diagnoses.
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Affiliation(s)
- Nour AlMozain
- Department of the Blood Bank, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Ayman Mashi
- Department of Laboratory and Bloo Bank, King Fahad Central Hospital, Ministry of Health, Jazan, Saudi Arabia
| | - Qasem Alneami
- Department of Laboratory and Bloo Bank, King Fahad Central Hospital, Ministry of Health, Jazan, Saudi Arabia
| | - Amal Al-Omran
- Medical student, King Saud University, College of Medicine, Riyadh, Saudi Arabia
| | - Nasir Bakshi
- Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Tarek Owaidah
- Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Salem Khalil
- Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Haitham Khogeer
- Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Shahrukh Hashmi
- Department of Medicine, Sheikh Shakbout Medical City, Abu Dhabi, United Arab Emirates
| | - Suleimman Al-Sweedan
- Department of Pediatrics, Jordan University of Science and Technology, Irbid, Jordan.
| | - Thomas Morris
- Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Randa AlNounou
- Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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13
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Prognostic Markers of Myelodysplastic Syndromes. ACTA ACUST UNITED AC 2020; 56:medicina56080376. [PMID: 32727068 PMCID: PMC7466347 DOI: 10.3390/medicina56080376] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 12/26/2022]
Abstract
Myelodysplastic syndrome (MDS) is a clonal disease characterized by multilineage dysplasia, peripheral blood cytopenias, and a high risk of transformation to acute myeloid leukemia. In theory, from clonal hematopoiesis of indeterminate potential to hematologic malignancies, there is a complex interplay between genetic and epigenetic factors, including miRNA. In practice, karyotype analysis assigns patients to different prognostic groups, and mutations are often associated with a particular disease phenotype. Among myeloproliferative disorders, secondary MDS is a group of special entities with a typical spectrum of genetic mutations and cytogenetic rearrangements resembling those in de novo MDS. This overview analyzes the present prognostic systems of MDS and the most recent efforts in the search for genetic and epigenetic markers for the diagnosis and prognosis of MDS.
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14
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Lesesve JF, Thomas B, Broséus J, Bain BJ. Macropolycytes: Severe stress time for neutrophils. Morphologie 2020; 104:214-216. [PMID: 32409276 DOI: 10.1016/j.morpho.2020.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/10/2020] [Accepted: 04/22/2020] [Indexed: 11/19/2022]
Abstract
Macropolycytes are giant neutrophils found in a variety of benign and neoplastic conditions. Since megaloblastic anaemia is one of the recognised causes of macropolycytes, other blood film features of megaloblastic anaemia should be sought when they harbor hypersegmented nuclei. When they are hypolobulated and hypogranular, the occurrence of a myelodysplastic syndrome must be investigated. Finding macropolycytes in the context of a nonspecific reactive granulopoiesis is more questionable but is often associated with stressed myelopoiesis and/or granulocyte colony-stimulating factor therapy.
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Affiliation(s)
- J-F Lesesve
- Service d'hématologie biologique, CHRU Nancy, 54511 Vandœuvre-lès-Nancy, France.
| | - B Thomas
- Laboratoire de biologie, hôpital Robert-Schuman, 57003 Metz, France.
| | - J Broséus
- Service d'hématologie biologique, CHRU Nancy, 54511 Vandœuvre-lès-Nancy, France.
| | - B J Bain
- Faculty of Medicine, Imperial College, South Kensington Campus, SW7 2AZ London, UK.
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15
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Serum ferritin levels at diagnosis predict prognosis in patients with low blast count myelodysplastic syndromes. Int J Hematol 2019; 110:533-542. [DOI: 10.1007/s12185-019-02710-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/12/2019] [Accepted: 07/17/2019] [Indexed: 12/13/2022]
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16
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Chisholm KM, Denton C, Keel S, Geddis AE, Xu M, Appel BE, Cantor AB, Fleming MD, Shimamura A. Bone Marrow Morphology Associated With Germline RUNX1 Mutations in Patients With Familial Platelet Disorder With Associated Myeloid Malignancy. Pediatr Dev Pathol 2019; 22:315-328. [PMID: 30600763 DOI: 10.1177/1093526618822108] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Germline mutations in RUNX1 result in autosomal dominant familial platelet disorder with associated myeloid malignancy (FPDMM). To characterize the hematopathologic features associated with a germline RUNX1 mutation, we reviewed a total of 42 bone marrow aspirates from 14 FPDMM patients, including 24 cases with no cytogenetic clonal abnormalities, and 18 with clonal karyotypes or leukemia. We found that all aspirate smears had ≥10% atypical megakaryocytes, predominantly characterized by small forms with hypolobated and eccentric nuclei, and forms with high nuclear-to-cytoplasmic ratios. Core biopsies showed variable cellularity and variable numbers of megakaryocytes with similar features to those in the aspirates. Granulocytic and/or erythroid dysplasia (≥10% cells per lineage) were present infrequently. Megakaryocytes with separate nuclear lobes were increased in patients with myelodysplastic syndrome (MDS) and acute leukemia. Comparison to an immune thrombocytopenic purpura cohort confirms increased megakaryocytes with hypolobated eccentric nuclei in FPDMM patients. As such, patients with FPDMM often have atypical megakaryocytes with small hypolobated and eccentric nuclei even in the absence of clonal cytogenetic abnormalities; these findings are related to the underlying RUNX1 germline mutation and not diagnostic of MDS. Isolated megakaryocytic dysplasia in patients with unexplained thrombocytopenia should raise the possibility of an underlying germline RUNX1 mutation.
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Affiliation(s)
- Karen M Chisholm
- 1 Department of Laboratories, Seattle Children's Hospital, Seattle, Washington.,2 Department of Laboratory Medicine, University of Washington, Seattle, Washington.,3 Department of Pathology, Boston Children's Hospital, Boston, Massachusetts
| | - Christopher Denton
- 4 Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Sioban Keel
- 5 Division of Hematology, Department of Medicine, University of Washington, Seattle, Washington
| | - Amy E Geddis
- 6 Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, Washington.,7 Division of Hematology & Oncology, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Min Xu
- 1 Department of Laboratories, Seattle Children's Hospital, Seattle, Washington.,2 Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Burton E Appel
- 8 Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Children's Cancer Institute, Hackensack, New Jersey
| | - Alan B Cantor
- 9 Division of Hematology Oncology, Boston Children's Hospital, Boston, Massachusetts.,10 Department of Hematology Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Mark D Fleming
- 3 Department of Pathology, Boston Children's Hospital, Boston, Massachusetts
| | - Akiko Shimamura
- 9 Division of Hematology Oncology, Boston Children's Hospital, Boston, Massachusetts.,10 Department of Hematology Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
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17
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Buoro S, Lippi G. Harmonization of laboratory hematology: a long and winding journey. Clin Chem Lab Med 2019; 56:1575-1578. [PMID: 29630509 DOI: 10.1515/cclm-2018-0161] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Sabrina Buoro
- Clinical Chemistry Laboratory, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University Hospital of Verona, Piazzale LA Scuro, 37100 Verona, Italy
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18
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Boutault R, Peterlin P, Boubaya M, Sockel K, Chevallier P, Garnier A, Guillaume T, Le Bourgeois A, Debord C, Godon C, Le Bris Y, Theisen O, Kroschinsky F, Moreau P, Béné MC, Platzbecker U, Eveillard M. A novel complete blood count-based score to screen for myelodysplastic syndrome in cytopenic patients. Br J Haematol 2018; 183:736-746. [PMID: 30406952 DOI: 10.1111/bjh.15626] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/24/2018] [Indexed: 12/21/2022]
Abstract
The diagnosis of myelodysplastic syndromes (MDS) is often challenging, time- and resource-consuming. A thorough analysis of complete blood count (CBC) parameters could, however, help to screen for MDS among other causes of cytopenia. To test this hypothesis, 109 newly-diagnosed MDS patients and 399 cytopenic patients older than 50 years with confirmed absence of MDS were enrolled in a prospective study. Multiparametric analysis highlighted three CBC parameters that were significantly different between the two cohorts: mean corpuscular volume, absolute neutrophil count and median neutrophil complexity and width of dispersion of the events measured (Ne-WX), which were used to define an MDS-CBC score. This score enables the prediction of MDS with 86% sensitivity and 88% specificity. The MDS-CBC score excluded MDS in 89% of cytopenic controls. Moreover, high score values at MDS diagnosis significantly correlated with decreased event-free (P = 0·02) and overall survival (P = 0·01). The power of this score was confirmed in an independent validation cohort (MDS n = 34, cytopenic controls n = 28). The MDS-CBC score is an easy and fast tool to exclude or suspect MDS in unselected patients with cytopenia of unknown reasons at the time of analysis, by prompting blood smear examination. It may thus improve allocation of further MDS-specific work-up in patients with cytopenia at the time of CBC assessment.
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Affiliation(s)
| | | | - Marouane Boubaya
- Clinical Research, Avicenne University Hospital, Bobigny, Germany
| | - Katja Sockel
- Universitätsklinikum "Carl Gustav Carus" der Technischen Universität Dresden, Dresden, Germany.,German Cancer Consortium (DKTK) and National Center for Tumor Diseases (NCT) Dresden, Dresden, Germany
| | | | | | | | | | | | | | | | | | - Frank Kroschinsky
- Universitätsklinikum "Carl Gustav Carus" der Technischen Universität Dresden, Dresden, Germany.,German Cancer Consortium (DKTK) and National Center for Tumor Diseases (NCT) Dresden, Dresden, Germany
| | | | | | - Uwe Platzbecker
- Universitätsklinikum "Carl Gustav Carus" der Technischen Universität Dresden, Dresden, Germany.,German Cancer Consortium (DKTK) and National Center for Tumor Diseases (NCT) Dresden, Dresden, Germany.,Medical Clinic and Policlinic 1 University Hospital Leizpig, Leipzig, Germany
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19
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Matsuda A, Kawabata H, Tohyama K, Maeda T, Araseki K, Hata T, Suzuki T, Kayano H, Shimbo K, Usuki K, Chiba S, Ishikawa T, Arima N, Nohgawa M, Ohta A, Miyazaki Y, Nakao S, Ozawa K, Arai S, Kurokawa M, Mitani K, Takaori-Kondo A. Interobserver concordance of assessments of dysplasia and blast counts for the diagnosis of patients with cytopenia: From the Japanese central review study. Leuk Res 2018; 74:137-143. [DOI: 10.1016/j.leukres.2018.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 05/29/2018] [Accepted: 06/05/2018] [Indexed: 11/29/2022]
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20
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Bennett JM. Morphologic dysplasia in Myelodysplastic Syndromes: How accurate are morphologists? Leuk Res 2018; 71:34-35. [PMID: 29957243 DOI: 10.1016/j.leukres.2018.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/20/2018] [Indexed: 11/17/2022]
Affiliation(s)
- John M Bennett
- University of Rochester Medical Center, Rochester, New York, USA.
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21
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Liu L, Wang J, Jiang Y, Xie H, Tang X, Li Q, Wang H, Zou P, Miao Z, Lv Y, Wang H, Cao Z, Zhao Z. EVI1 expression predicts outcome in higher-risk myelodysplastic syndrome patients. Leuk Lymphoma 2018; 59:2929-2940. [PMID: 29846125 DOI: 10.1080/10428194.2018.1459615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Lin Liu
- Department of Hematology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin, PR China
| | - Jinhuan Wang
- Department of Oncology, Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin, PR China
| | - Yanan Jiang
- Department of Hematology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin, PR China
| | - Huan Xie
- Department of Hematology, First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Xiaoqiong Tang
- Department of Hematology, First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Qiubai Li
- Department of Hematology, The Union Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, PR China
| | - Huaquan Wang
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Ping Zou
- Department of Hematology, The Union Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, PR China
| | - Zhaoyi Miao
- Department of Hematology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin, PR China
| | - Yangyang Lv
- Department of Hematology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin, PR China
| | - Haitao Wang
- Department of Oncology, Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin, PR China
| | - Zeng Cao
- Department of Hematology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin, PR China
| | - Zhigang Zhao
- Department of Hematology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin, PR China
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22
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Zini G. Diagnostics and Prognostication of Myelodysplastic Syndromes. Ann Lab Med 2018; 37:465-474. [PMID: 28840983 PMCID: PMC5587818 DOI: 10.3343/alm.2017.37.6.465] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/07/2017] [Accepted: 08/02/2017] [Indexed: 12/17/2022] Open
Abstract
MDS are a heterogeneous and complex group of clonal hematological neoplasms arising from a hematopoietic stem cell, and characterized by ineffective hematopoiesis, resulting in increased apoptosis in the bone marrow and peripheral cytopenia, which involves one or more lineages. Epigenetic changes are reported as ‘founder’ mutations in the case of MDS. Its incidence in the general population has been reported as five new MDS diagnoses per 100,000 people. It affects men more frequently than it does women, and its incidence increases with age. The diagnostic classification, now in use, is the one of the World Health Organization, revised in August 2016. It recognizes six distinct entities in addition to a provisional entity of childhood. In most of the cases, diagnosis is based on the morphologic quantitative and qualitative evaluation of the peripheral blood and bone marrow using basic hematological techniques. Bone marrow biopsy and flow cytometric immunophenotyping also offer support for further diagnostic elucidation, while cytogenetics and molecular genetics are presently fully integrated into prognostication, treatment processes, and decision-making.
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Affiliation(s)
- Gina Zini
- Department of Oncology and Hematology, Blood Transfusion Service, Policlinico Gemelli Foundation, Catholic University of Sacred Heart, Rome, Italy.
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23
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Tohyama K. Present status and perspective of laboratory hematology in Japan: On the standardization of blood cell morphology including myelodysplasia: On behalf of the Japanese Society for Laboratory Hematology. Int J Lab Hematol 2018; 40 Suppl 1:120-125. [PMID: 29741254 DOI: 10.1111/ijlh.12819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 02/07/2018] [Indexed: 11/30/2022]
Abstract
The Japanese Society for Laboratory Hematology (JSLH) was launched in 2000 and has been developed by a mutual collaboration of hematologists, medical technologists, and the companies involved in hematological laboratory testing. The aim of JSLH is the progress and development of laboratory hematology by academic conferences, periodic publication of academic journal, training and education (in the meeting, the journal, or the website), promotion of the standardization of laboratory hematology, and certification of the laboratory hematology specialists. Among 3 specialized committees organized for the standardization of laboratory hematology, the standardization committee on blood cell morphology has been dealing with the various projects on peripheral/bone marrow blood cells and normal/abnormal morphology. Another independent organization, the Japanese National Research Group on idiopathic bone marrow failure syndromes (BMF), has raised the importance of the dysplasia of myelodysplastic syndromes (MDS) and has been conducting the prospective registration, central review, and follow-up study of MDS. This group recently proposed the grading system for diagnostic accuracy of MDS, and the detailed procedure of morphological diagnosis of MDS is presented in the specialized color atlas with typical photographs of various dysplasia. JSLH has also approved the grading system for diagnostic accuracy of MDS and adopted this standardized diagnostic system to the educational item for certification of the laboratory hematology specialists, aiming at a nationwidely expanding morphological evaluation of myelodysplasia. Further and significant progress in the standardization of blood cell morphology will be expected in Japan through the activity of JSLH.
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Affiliation(s)
- K Tohyama
- Department of Laboratory Medicine, Kawasaki Medical School, Kurashiki-City, Okayama, Japan
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24
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Sasada K, Yamamoto N, Masuda H, Tanaka Y, Ishihara A, Takamatsu Y, Yatomi Y, Katsuda W, Sato I, Matsui H. Inter-observer variance and the need for standardization in the morphological classification of myelodysplastic syndrome. Leuk Res 2018; 69:54-59. [PMID: 29656215 DOI: 10.1016/j.leukres.2018.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/23/2018] [Accepted: 04/03/2018] [Indexed: 01/29/2023]
Abstract
In this era of genome medicine, the sub-classification of myeloid neoplasms, including myelodysplastic syndrome (MDS), is now supported by genetic testing in selected cases. However, as the initial suspicion and primary diagnosis of the disease still largely relies on morphological features and numbers of hematopoietic cells, the establishment of a uniform diagnostic basis, especially for cell morphology, is essential. In this study, we collected nearly 100,000 hematopoietic cell images from 499 peripheral blood smear specimens from patients with MDS and used these to evaluate the standardization of morphological classification by medical technologists. The observers in this study ranged between two to eleven for each image, and the images were classified according to MDS criteria through a web-based system. We found considerable inter-observer variance in the assessment of dysplastic features. Observers did not recognize cytoplasmic hypo-granularity unless almost all granules in neutrophils were absent. Pseudo Pelger-Huët anomalies were also often overlooked, except for cells with a very typical "pince-nez" appearance. Taken together, this study suggests a requirement for further standardization in terms of morphological cell classification, and a need for the development of automatic cell classification-supporting devices for the accurate diagnosis of MDS.
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Affiliation(s)
- Keiko Sasada
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto University, Japan
| | - Noriko Yamamoto
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto University, Japan
| | - Hiroki Masuda
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto University, Japan
| | - Yoko Tanaka
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto University, Japan
| | - Ayako Ishihara
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto University, Japan
| | - Yasushi Takamatsu
- Department of Medical Oncology, Hematology and Infectious Diseases, Fukuoka University, Japan
| | - Yutaka Yatomi
- Department of Clinical Laboratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | | | - Issei Sato
- Medical Image Analysis Team, Center for Advanced Intelligence Project, Institute of Physical and Chemical Research (RIKEN), Japan
| | - Hirotaka Matsui
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto University, Japan; Medical Image Analysis Team, Center for Advanced Intelligence Project, Institute of Physical and Chemical Research (RIKEN), Japan; Department of Molecular Laboratory Medicine, Faculty of Life Sciences, Kumamoto University, Japan.
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25
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Buoro S, Da Rin G, Fanelli A, Lippi G. Harmonization of interpretative comments in laboratory hematology reporting: the recommendations of the Working Group on Diagnostic Hematology of the Italian Society of Clinical Chemistry and Clinical Molecular Biology (WGDH-SIBioC). ACTA ACUST UNITED AC 2018; 57:66-77. [DOI: 10.1515/cclm-2017-0972] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 01/02/2018] [Indexed: 12/13/2022]
Abstract
Abstract
The goal of harmonizing laboratory testing is contributing to improving the quality of patient care and ultimately ameliorating patient outcome. The complete blood and leukocyte differential counts are among the most frequently requested clinical laboratory tests. The morphological assessment of peripheral blood cells (PB) through microscopic examination of properly stained blood smears is still considered a hallmark of laboratory hematology. Nevertheless, a variable inter-observer experience and the different terminology used for characterizing cellular abnormalities both contribute to the current lack of harmonization in blood smear revision. In 2014, the Working Group on Diagnostic Hematology of the Italian Society of Clinical Chemistry and Clinical Molecular Biology (WGDH-SIBioC) conducted a national survey, collecting responses from 78 different Italian laboratories. The results of this survey highlighted a lack of harmonization of interpretative comments in hematology, which prompted the WGDH-SIBioC to develop a project on “Harmonization of interpretative comments in the laboratory hematology report”, aimed at identifying appropriate comments and proposing a standardized reporting system. The comments were then revised and updated according to the 2016 revision of the World Health Organization classification of hematologic malignancies. In 2016, the Working Group on Diagnostic Hematology of the Italian Society of Clinical Chemistry and Clinical Molecular Biology (WGDH SIBioC) published its first consensus based recommendation for interpretative comments in laboratory hematology reporting whit the purpose of evaluating comments and the aim to (a) reducing their overall number, (b) standardizing the language, (c) providing information that could be easily comprehended by clinicians and patients, (d) increasing the quality of the clinical information, and (e) suggesting additional diagnostic tests when necessary. This paper represents a review of the recommendations of the former document.
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Affiliation(s)
- Sabrina Buoro
- Clinical Chemistry Laboratory, Hospital Papa Giovanni XXIII , Bergamo , Italy
| | - Giorgio Da Rin
- Laboratory Medicine, San Bassiano Hospital , AULSS 7 Pedemontana, Via dei Lotti, 40 , 36061 Bassano del Grappa , Italy
| | | | - Giuseppe Lippi
- Section of Clinical Biochemistry , University Hospital of Verona , Verona , Italy
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26
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Shaver AC, Seegmiller AC. Nuances of Morphology in Myelodysplastic Diseases in the Age of Molecular Diagnostics. Curr Hematol Malig Rep 2017; 12:448-454. [DOI: 10.1007/s11899-017-0405-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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27
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La Gioia A, Fumi M, Pezzati P, Balboni F, Pancione Y, Rocco L, Sale S, Bombara M, Fiorini M, Fiorini F, Rocco V. Automatic wedge smears preparation may cause traumatic morphological changes in peripheral blood cells. J Clin Pathol 2017; 71:168-171. [DOI: 10.1136/jclinpath-2017-204580] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/12/2017] [Accepted: 07/19/2017] [Indexed: 11/03/2022]
Abstract
In recent years, several automated analysers that prepare and stain blood smears have been introduced in clinical laboratories. Despite the use of instrumental settings based on physical characteristic of individual samples, traumatic injuries of neutrophil and lymphocytes can be observed. Some samples present a very high percentage of damaged cells, allowing the speculation that a cellular susceptibility may enhance mechanical traumatism. These artefacts can puzzle morphological evaluation in both traditional and digitised microscopy; in addition, unskilled operators can be misled.
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28
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Kawabata H, Tohyama K, Matsuda A, Araseki K, Hata T, Suzuki T, Kayano H, Shimbo K, Zaike Y, Usuki K, Chiba S, Ishikawa T, Arima N, Nogawa M, Ohta A, Miyazaki Y, Mitani K, Ozawa K, Arai S, Kurokawa M, Takaori-Kondo A. Validation of the revised International Prognostic Scoring System in patients with myelodysplastic syndrome in Japan: results from a prospective multicenter registry. Int J Hematol 2017; 106:375-384. [DOI: 10.1007/s12185-017-2250-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/08/2017] [Accepted: 05/09/2017] [Indexed: 02/08/2023]
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29
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Abstract
Bloodstream infections (BSI) carry a heavy burden of morbidity and mortality in modern internal medicine wards (IMW). These wards are often filled with elderly subjects with several risk factors for BSI, such as multiple comorbidities, polypharmacy, immunosuppression, and indwelling devices. Diagnosing BSI in such a setting might require a high degree of suspicion, since the clinical presentation could be affected by underlying conditions and concomitant medications, which might delay the administration of an appropriate antimicrobial therapy, an event strongly and unfavorably influencing survival. Furthermore, selecting the appropriate antimicrobial therapy to treat these patients is becoming an increasingly complex task in which all possible benefits and costs should be carefully analyzed from patient and public health perspectives. Only a specialized, continuous, and interdisciplinary approach could really improve the management of IMW patients in an era of increasing antimicrobial resistance and complexity of care.
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Affiliation(s)
- Valerio Del Bono
- a Clinica Malattie Infettive, IRCCS AOU San Martino-IST, Università di Genova , Genova , Italy
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30
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Reassessment of H&E stained clot specimens and immunohistochemistry of phosphorylated Stat5 for histological diagnosis of MDS/MPN. Pathology 2015; 47:673-7. [DOI: 10.1097/pat.0000000000000328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Inaba T, Ishizuka K, Yuasa S, Mishima N, Ogura K, Saito K, Kohno T, Fujitomo Y, Nakanishi M, Fujita N. Abnormal neutrophil scattergram obtained using Pentra MS CRP in the patients with myelodysplastic syndrome showing dysgranulopoiesis. Int J Lab Hematol 2015; 38:27-33. [PMID: 26333345 DOI: 10.1111/ijlh.12423] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 08/07/2015] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Pentra MS CRP is an automated hematology analyzer capable of cytochemistry using Chlorazol black E, a lipid-staining agent, for white blood cell (WBC) differentials. Pentra MS CRP displays a WBC scattergram according to the cell volume obtained using flow impedance and light absorbance reflecting the Chlorazol black E (CBE)-positive lipid content. METHOD Neutrophil scattergrams obtained using Pentra MS CRP were compared between 5 patients with myelodysplastic syndrome (MDS) and normal controls. Sudan black B (SBB)-staining patterns of peripheral blood neutrophils were subdivided into four types (types I, II, III, and VI) based on their staining intensity and scored by counting 200 cells. Such SBB scores were also compared between the two groups. RESULTS Neutrophil scattergrams deviated downward in the MDS group, suggesting the decreased CBE positivity that seemed reflect the reduction of the lipid content in dysplastic neutrophils. SBB scores determined in this study were also decreased in the MDS group when compared with those in normal controls. CONCLUSION Pentra MS CRP might rapidly generate useful information on dysplastic neutrophils in patients with MDS based on its cytochemistry for WBC differentials during routine laboratory hematology.
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Affiliation(s)
- T Inaba
- Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - K Ishizuka
- Department of Medical Instrumental Research and Technology, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Horiba, Ltd., Kyoto, Japan
| | - S Yuasa
- Department of Medical Instrumental Research and Technology, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Horiba, Ltd., Kyoto, Japan
| | | | | | - K Saito
- Department of Medical Instrumental Research and Technology, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Horiba, Ltd., Kyoto, Japan
| | - T Kohno
- Department of Medical Instrumental Research and Technology, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Horiba, Ltd., Kyoto, Japan
| | - Y Fujitomo
- Department of Medical Instrumental Research and Technology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - M Nakanishi
- Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - N Fujita
- Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Importance of classical morphology in the diagnosis of myelodysplastic syndrome. Mediterr J Hematol Infect Dis 2015; 7:e2015035. [PMID: 25960863 PMCID: PMC4418392 DOI: 10.4084/mjhid.2015.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 04/23/2015] [Indexed: 01/16/2023] Open
Abstract
Myelodysplastic syndromes (MDS) are hematopoietic stem cell disorders characterized by dysplastic, ineffective, clonal and neoplastic hematopoiesis. MDS represent a complex hematological problem: differences in disease presentation, progression and outcome have necessitated the use of classification systems to improve diagnosis, prognostication, and treatment selection. However, since a single biological or genetic reliable diagnostic marker has not yet been discovered for MDS, quantitative and qualitative dysplastic morphological alterations of bone marrow precursors and peripheral blood cells are still fundamental for diagnostic classification. In this paper, World Health Organization (WHO) classification refinements and current minimal diagnostic criteria proposed by expert panels are highlighted, and related problematic issues are discussed. The recommendations should facilitate diagnostic and prognostic evaluations in MDS and selection of patients for new effective targeted therapies. Although, in the future, morphology should be supplemented with new molecular techniques, the morphological approach, at least for the moment, is still the cornerstone for the diagnosis and classification of these disorders.
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Palmer L, Briggs C, McFadden S, Zini G, Burthem J, Rozenberg G, Proytcheva M, Machin SJ. ICSH recommendations for the standardization of nomenclature and grading of peripheral blood cell morphological features. Int J Lab Hematol 2015; 37:287-303. [DOI: 10.1111/ijlh.12327] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 12/10/2014] [Indexed: 01/11/2023]
Affiliation(s)
- L. Palmer
- Haematology Laboratory; Middlemore Hospital; Auckland New Zealand
| | - C. Briggs
- University College London Hospitals; London UK
| | | | - G. Zini
- Università Cattolica del Sacro Cuore; Rome Italy
| | - J. Burthem
- Institute of Cancer Sciences; University of Manchester; Manchester UK
| | - G. Rozenberg
- SEALS Randwick; Prince of Wales Hospital; Randwick NSW Australia
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Della Porta MG, Travaglino E, Boveri E, Ponzoni M, Malcovati L, Papaemmanuil E, Rigolin GM, Pascutto C, Croci G, Gianelli U, Milani R, Ambaglio I, Elena C, Ubezio M, Da Via’ MC, Bono E, Pietra D, Quaglia F, Bastia R, Ferretti V, Cuneo A, Morra E, Campbell PJ, Orazi A, Invernizzi R, Cazzola M. Minimal morphological criteria for defining bone marrow dysplasia: a basis for clinical implementation of WHO classification of myelodysplastic syndromes. Leukemia 2014; 29:66-75. [DOI: 10.1038/leu.2014.161] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 04/19/2014] [Accepted: 05/07/2014] [Indexed: 02/08/2023]
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