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Rennie M, Lin G, Scarlata S. Multiple functions of phospholipase Cβ1 at a glance. J Cell Sci 2022; 135:276667. [PMID: 36125065 DOI: 10.1242/jcs.260282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Phospholipase Cβ (PLCβ) is the main effector of the Gq family of heterotrimeric G proteins that transduces signals from hormones and neurotransmitters into Ca2+ signals. While PLCβ is critical for Ca2+ responses, recent studies have suggested that PLCβ has additional roles independent of its lipase activity. These novel functions are carried out by a cytosolic population of PLCβ that binds and inhibits the component 3 promoter of RNA-induced silencing complex (C3PO) to impact cytosolic RNA populations. Additionally, cytosolic PLCβ binds to stress granule proteins, keeping them dispersed and thus inhibiting stress granule formation. Upon activation of the Gα subunit of Gq (Gαq), cytosolic PLCβ relocalizes to the membrane, releasing C3PO and stress granule proteins, which in turn promotes activation of C3PO and RNA processing, as well as sequestration of specific transcripts into newly formed stress granules. As highlighted in this Cell Science at a Glance and the accompanying poster, the link between Gαq signaling, increased intracellular Ca2+ and changes in RNA processing impacts neuronal cell differentiation and may also affect neuronal development and dysfunction.
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Affiliation(s)
- Madison Rennie
- Department of Chemistry and Biochemistry, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA 01609, USA
| | - Guanyu Lin
- Department of Chemistry and Biochemistry, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA 01609, USA
| | - Suzanne Scarlata
- Department of Chemistry and Biochemistry, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA 01609, USA
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2
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Kaniyattu SM, Meenakshi A, Kumar MB, Kumar KR, Rao S, Shetty PD, Shetty V, Shetty JK, Shetty PK. Cytogenetic and cytokine profile in elderly patients with cytopenia. Exp Hematol 2020; 89:80-86. [PMID: 32739457 DOI: 10.1016/j.exphem.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/06/2020] [Accepted: 07/26/2020] [Indexed: 10/23/2022]
Abstract
In the elderly with cytopenia, the diagnosis of myelodysplastic syndrome (MDS) may be missed. Cytokine levels contribute to the pathology of MDS. Hence, the objectives were to evaluate cytogenetic profile as a prognostic indicator in risk stratification and cytokine levels as a screening tool in patients with cytopenia for diagnosis. Over 2 years (2016-2018), 150 elderly patients were screened. MDS diagnosis was confirmed by morphology. Interleukin-2 (IL-2) and IL-6 levels were assessed in 50 patients, and karyotyping was performed in 20 confirmed cases of MDS. Age-matched healthy controls were used for comparison of cytokine levels. Among 150 patients, 88.6% had anemia, including nutritional anemia (51.2%). MDS diagnosis was confirmed in 35 patients. In 15 patients, unexplained cytopenia (UC) was present. Karyotyping in 20 MDS patients was normal in 15 (75%) patients and revealed a complex karyotype in four (20%) patients and double chromosomal abnormality in one (5%) patient. The Revised International Prognostic Scoring System (IPSS-R) scored 91% in the low-risk group and 9% (n = 3) in the high-risk group; the latter three developed acute myeloid leukemia (AML) and two of them had a 7q deletion. Among the 15 cases of UC, one patient died from refractory anemia. No significant difference in levels of IL-2 and IL-6 were found between MDS and UC patients when compared with healthy controls, as well as between different risk groups and karyotypes. A significant difference in IL-2 levels was found in MDS patients with disease progression and with stable disease. On the basis of the findings, it is suggested that IL-2 levels will help in predicting disease progression.
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Affiliation(s)
| | - Arumugam Meenakshi
- K. S. Hegde Medical Academy, Nitte (Deemed to Be University), Deralakatte, Mangaluru, India
| | - Mohana B Kumar
- K. S. Hegde Medical Academy, Nitte (Deemed to Be University), Deralakatte, Mangaluru, India
| | | | - Shama Rao
- K. S. Hegde Medical Academy, Nitte (Deemed to Be University), Deralakatte, Mangaluru, India
| | - Prashanth D Shetty
- K. S. Hegde Medical Academy, Nitte (Deemed to Be University), Deralakatte, Mangaluru, India
| | - Vijith Shetty
- K. S. Hegde Medical Academy, Nitte (Deemed to Be University), Deralakatte, Mangaluru, India
| | - Jayaprakash K Shetty
- K. S. Hegde Medical Academy, Nitte (Deemed to Be University), Deralakatte, Mangaluru, India
| | - Padma K Shetty
- K. S. Hegde Medical Academy, Nitte (Deemed to Be University), Deralakatte, Mangaluru, India.
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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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Sweeney MR, Applebaum KM, Arem H, Braffett BH, Poynter JN, Robien K. Medical Conditions and Modifiable Risk Factors for Myelodysplastic Syndrome: A Systematic Review. Cancer Epidemiol Biomarkers Prev 2019; 28:1502-1517. [DOI: 10.1158/1055-9965.epi-19-0106] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/13/2019] [Accepted: 06/13/2019] [Indexed: 11/16/2022] Open
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Slack J, Nguyen L, Naugler C, Rashid-Kolvear F. Incidence of Myelodysplastic Syndromes in a Major Canadian Metropolitan Area. J Appl Lab Med 2018; 3:378-383. [PMID: 33636921 DOI: 10.1373/jalm.2018.026500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/14/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal stem cell disorders that can progress to acute myeloid leukemia. In many regions of the world, the epidemiology of MDS is poorly described. This study determines the crude incidence of MDS in Calgary, Alberta, Canada, with new cases diagnosed using the revised 2008 WHO criteria. METHODS For the study period of January 1, 2011 to December 31, 2015, incident cases of MDS were identified from a centralized database maintained by Calgary Laboratory Services' Cancer Cytogenetics Laboratory, which receives and analyzes patient bone marrow samples from southern Alberta. RESULTS The Calgary metropolitan area had a total incidence rate of 2.60 MDS cases per 100000 person years, corresponding to an age-standardized incidence of 3.69 for Canada. The male-to-female sex ratio was 1.35, and the median age at diagnosis was 75 years. With these results, 1295 new annual cases of MDS were predicted in Canada. CONCLUSIONS The reported incidence rate, sex, and age distribution were consistent with data around the world including several developing nations. This is the first study to provide information regarding the epidemiology of MDS within Canada.
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Affiliation(s)
- Jonathan Slack
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Calgary Laboratory Services, Calgary, AB, Canada
| | - Leonard Nguyen
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Naugler
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Calgary Laboratory Services, Calgary, AB, Canada.,Departments of Family Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Fariborz Rashid-Kolvear
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Calgary Laboratory Services, Calgary, AB, Canada
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Mayer F, Faglioni L, Agabiti N, Fenu S, Buccisano F, Latagliata R, Ricci R, Spiriti MAA, Tatarelli C, Breccia M, Cimino G, Fianchi L, Criscuolo M, Gumenyuk S, Mancini S, Maurillo L, Nobile C, Niscola P, Piccioni AL, Tafuri A, Trapè G, Andriani A, De Fabritiis P, Voso MT, Davoli M, Zini G. A Population-Based Study on Myelodysplastic Syndromes in the Lazio Region (Italy), Medical Miscoding and 11-Year Mortality Follow-Up: the Gruppo Romano-Laziale Mielodisplasie Experience of Retrospective Multicentric Registry. Mediterr J Hematol Infect Dis 2017; 9:e2017046. [PMID: 28698789 PMCID: PMC5499502 DOI: 10.4084/mjhid.2017.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/05/2017] [Indexed: 01/25/2023] Open
Abstract
Data on Myelodysplastic Syndromes (MDS) are difficult to collect by cancer registries because of the lack of reporting and the use of different classifications of the disease. In the Lazio Region, data from patients with a confirmed diagnosis of MDS, treated by a hematology center, have been collected since 2002 by the Gruppo Romano-Laziale Mielodisplasie (GROM-L) registry, the second MDS registry existing in Italy. This study aimed at evaluating MDS medical miscoding during hospitalizations, and patients' survival. For these purposes, we selected 644 MDS patients enrolled in the GROM-L registry. This cohort was linked with two regional health information systems: the Hospital Information System (HIS) and the Mortality Information System (MIS) in the 2002-2012 period. Of the 442 patients who were hospitalized at least once during the study period, 92% had up to 12 hospitalizations. 28.5% of patients had no hospitalization episodes scored like MDS, code 238.7 of the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM). The rate of death during a median follow-up of 46 months (range 0.9-130) was 45.5%. Acute myeloid leukemia (AML) was the first cause of mortality, interestingly a relevant portion of deaths is due to cerebro-cardiovascular events and second tumors. This study highlights that MDS diagnosis and treatment, which require considerable healthcare resources, tend to be under-documented in the HIS archive. Thus we need to improve the HIS to better identify information on MDS hospitalizations and outcome. Moreover, we underline the importance of comorbidity in MDS patients' survival.
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Affiliation(s)
- Flavia Mayer
- Department of Epidemiology, Lazio Regional Health Service(Italy)
| | - Laura Faglioni
- Hematology Dep. Az. Osp. San Giovanni-Addolorata Rome(Italy)
| | - Nera Agabiti
- Department of Epidemiology, Lazio Regional Health Service(Italy)
| | - Susanna Fenu
- Hematology Dep. Az. Osp. San Giovanni-Addolorata Rome(Italy)
| | | | - Roberto Latagliata
- Dep of Cellular Biotechnology and Hematology, University “La Sapienza” Rome (Italy)
| | - Roberto Ricci
- Dep of Cellular Biotechnology and Hematology, University “La Sapienza” Rome (Italy)
| | | | | | - Massimo Breccia
- Dep of Cellular Biotechnology and Hematology, University “La Sapienza” Rome (Italy)
| | - Giuseppe Cimino
- Dep. of Cellular Biotechnology and Hematology, University of Rome “Sapienza”–Polo Pontino, Latina(Italy)
| | - Luana Fianchi
- Hematology Institute Università Cattolica del Sacro Cuore Rome (Italy)
| | | | - Svitlana Gumenyuk
- Hematology and Stem Cell Transplantation Unit, Regina Elena National Cancer Institute Rome (Italy)
| | - Stefano Mancini
- Hematology Unit Az. Osp. San Camillo-Forlanini, Rome (Italy)
| | | | | | | | | | - Agostino Tafuri
- Hematology Unit Sant’ Andrea Univ. “La Sapienza “ Rome (Italy)
| | - Giulio Trapè
- Hematology Unit Az. Osp. Belcolle Viterbo (Italy)
| | | | | | | | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service(Italy)
| | - Gina Zini
- Hematology Institute Università Cattolica del Sacro Cuore Rome (Italy)
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Marino CL, Tran JNSN, Stokol T. Atypical chronic myeloid leukemia in a German Shepherd Dog. J Vet Diagn Invest 2017; 29:338-345. [DOI: 10.1177/1040638716689581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 4-y-old neutered male German Shepherd Dog was presented with a 3-d duration of lethargy, restlessness, and vomiting. Physical examination revealed generalized lymphadenopathy, pale mucous membranes, systolic heart murmur, dehydration, and fever. Hematologic abnormalities included moderate-to-marked leukocytosis, characterized by neutrophilia with a left shift to progranulocytes and 2% presumptive myeloid blasts, marked anemia that was nonregenerative, and marked thrombocytopenia. Dysplasia was evident in neutrophils and platelets. Bone marrow examination revealed marked myeloid and megakaryocytic hyperplasia with 7% blasts, erythroid hypoplasia, and trilineage dysplasia. Flow cytometric analysis confirmed that bone marrow cells were mostly of neutrophil lineage, with reduced expression of common leukocyte antigens (CD45, CD18) and neutrophil-specific antigen. Bone marrow cells were cytogenetically analyzed for the breakpoint cluster region–Abelson oncogene using multicolor fluorescent in situ hybridization. The genetic aberration was present in 7% of cells, which was a negative result (>10% of cells is considered positive). Euthanasia was elected. Histologic examination showed extensive infiltration of multiple organs by neoplastic myeloid cells, with effacement of lymph node and splenic architecture. The final diagnosis was atypical chronic myeloid leukemia (aCML), an uncommon myeloproliferative disorder with features of myelodysplastic syndromes (dysplasia) and chronic leukemia (neutrophilic leukocytosis with <20% marrow blasts, extramedullary infiltrates). The trilineage dysplasia, lack of monocytosis, and supporting cytogenetics distinguish aCML from CML, chronic neutrophilic leukemia, and chronic myelomonocytic leukemia.
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Affiliation(s)
- Christina L. Marino
- Department of Clinical Studies, College of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA (Marino)
- Departments of Biomedical Sciences (Tran), College of Veterinary Medicine, Cornell University, Ithaca, NY
- Population Medicine and Diagnostic Sciences (Stokol), College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - Jimmy N. S. N. Tran
- Department of Clinical Studies, College of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA (Marino)
- Departments of Biomedical Sciences (Tran), College of Veterinary Medicine, Cornell University, Ithaca, NY
- Population Medicine and Diagnostic Sciences (Stokol), College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - Tracy Stokol
- Department of Clinical Studies, College of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA (Marino)
- Departments of Biomedical Sciences (Tran), College of Veterinary Medicine, Cornell University, Ithaca, NY
- Population Medicine and Diagnostic Sciences (Stokol), College of Veterinary Medicine, Cornell University, Ithaca, NY
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8
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Minetto P, Guolo F, Clavio M, De Astis E, Colombo N, Grasso R, Fugazza G, Sessarego M, Lemoli RM, Gobbi M, Miglino M. Combined assessment of WT1 and BAALC gene expression at diagnosis may improve leukemia-free survival prediction in patients with myelodysplastic syndromes. Leuk Res 2015; 39:866-73. [DOI: 10.1016/j.leukres.2015.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 03/08/2015] [Accepted: 04/19/2015] [Indexed: 11/24/2022]
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9
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Sperr WR, Kundi M, Wimazal F, Nösslinger T, Schönmetzler-Makrai A, Stauder R, Krieger O, Neukirchen J, Germing U, Pfeilstöcker M, Valent P. Proposed score for survival of patients with myelodysplastic syndromes. Eur J Clin Invest 2013; 43:1120-8. [PMID: 24102333 DOI: 10.1111/eci.12149] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 08/03/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patient selection for various therapies in myelodysplastic syndromes (MDS) is based on prognostic factors, scoring systems and the individual life expectancy. However, most established risk scores include mainly disease-related parameters and thus focus on leukaemia-transformation rather than survival. PATIENTS AND METHODS To establish a risk score optimized for prediction of survival, we analysed international prognostic scoring system (IPSS)-related and IPSS-independent variables in 400 patients with primary MDS (median age: 71 years; range 18-91) of the Austrian MDS platform. Patients were randomly split into a learning sample (60%) and validation sample (40%). External validation was performed on 93 patients from the Heinrich Heine University (Duesseldorf/Germany). RESULTS By multivariate analysis, IPSS, ferritin, age and comorbidities were found to be independent predictive variables concerning survival. Based on weighing these prognostic parameters against each other, we established a novel survival score employing IPSS, ferritin (< 900 ng/mL = 0; ≥ 900 ng/mL = 1), age (< 70 years = 0; 70-79 years = 1; ≥ 80 years = 1.5) and HCT-CI comorbidity (low/intermediate = 0; high = 0.5). Using this score, four prognostic risk groups could be discriminated in the validation sample, with highly significant differences in life expectancy [median survival: LowS (score 0), not reached; Int-1S (score 0.5-1.0), 3.84 years; Int-2S (score 1.5-2.0): 2.72 years; and HighS (score > 2.0): 0.80 years; P < 0.0001]. CONCLUSIONS Our newly proposed score may be a useful tool for survival prediction in MDS and helpful in patient selection for various therapies in daily practice and clinical trials.
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Affiliation(s)
- Wolfgang R Sperr
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
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10
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Li N, Abe S, Kurata M, Abe-Suzuki S, Onishi I, Kirimura S, Murayama T, Hidaka M, Kawano F, Kitagawa M. Over-expression of cancerous inhibitor of PP2A (CIP2A) in bone marrow cells from patients with a group of high-risk myelodysplastic syndromes. Pathol Oncol Res 2013; 20:399-407. [PMID: 24163288 DOI: 10.1007/s12253-013-9709-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 10/02/2013] [Indexed: 12/25/2022]
Abstract
Cancerous inhibitor of PP2A (protein phosphatase 2A) (CIP2A) is an inhibitor of PP2A, a phosphatase and tumor suppressor that regulates cell proliferation, differentiation, and survival. The aim of this study was to investigate whether CIP2A plays a role in the progression of myelodysplastic syndromes (MDS). Immunohistochemical analysis revealed that a fraction patients having refractory anemia with excess blasts (RAEB)-1 (4 out of 12) and RAEB-2 (10 out of 14) exhibited significant expression of CIP2A in bone marrow hematopoietic cells, while all patients with refractory cytopenia with unilineage or multilineage dysplasia (RCUD/RCMD) (0 out of 18) and the control group (0 out of 17) were negative. CIP2A was mainly expressed by the MPO-positive myeloid series of cells and partly by the CD34-positive cells in association with the expression of phosphorylated c-MYC (p-c-MYC) protein and the cell cycle-related proteins Ki-67, MCM2, and geminin. The percentage of p-c-MYC-positive cells in the bone marrow of CIP2A-positive MDS cases was significantly higher than that in CIP2A-negative MDS cases (P < 0.01). The expression levels of mRNA for CIP2A and PP2A exhibited positive correlation in MDS/control bone marrow. These results suggest that up-regulated expression of CIP2A might play a role in the proliferation of blasts in the MDS bone marrow and in disease progression in at least some cases.
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Affiliation(s)
- Na Li
- Department of Comprehensive Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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11
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Otrock ZK, Tiu RV, Maciejewski JP, Sekeres MA. The need for additional genetic markers for myelodysplastic syndrome stratification: what does the future hold for prognostication? Expert Rev Hematol 2013; 6:59-68. [PMID: 23373781 DOI: 10.1586/ehm.12.67] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Myelodysplastic syndromes (MDS) constitute a heterogeneous group of clonal hematopoietic disorders. Metaphase cytogenetics has been the gold standard for genetic testing in MDS, but it detects clonal cytogenetic abnormalities in only 50% of cases. New karyotyping tests include FISH, array-based comparative genomic hybridization and single-nucleotide polymorphism arrays. These techniques have increased the detected genetic abnormalities in MDS, many of which confer prognostic significance to overall and leukemia-free survival. This has eventually increased our understanding of MDS genetics. With the help of new technologies, we anticipate that the existing prognostic scoring systems will incorporate mutational data into their parameters. This review discusses the progress in MDS diagnosis through the use of array-based technologies. The authors also discuss the recently investigated genetic mutations in MDS and revisit the MDS classification and prognostic scoring systems.
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Affiliation(s)
- Zaher K Otrock
- Leukemia Program, Cleveland Clinic Taussig Cancer Institute, OH 44195, USA
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12
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Senent L, Arenillas L, Luño E, Ruiz JC, Sanz G, Florensa L. Reproducibility of the World Health Organization 2008 criteria for myelodysplastic syndromes. Haematologica 2012; 98:568-75. [PMID: 23065505 DOI: 10.3324/haematol.2012.071449] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The reproducibility of the World Health Organization 2008 classification for myelodysplastic syndromes is uncertain and its assessment was the major aim of this study. The different peripheral blood and bone marrow variables required for an adequate morphological classification were blindly evaluated by four cytomorphologists in samples from 50 patients with myelodysplastic syndromes. The degree of agreement among observers was calculated using intraclass correlation coefficient and the generalized kappa statistic for multiple raters. The degree of agreement for the percentages of blasts in bone marrow and peripheral blood, ring sideroblasts in bone marrow, and erythroid, granulocytic and megakaryocytic dysplastic cells was strong (P<0.001 in all instances). After stratifying the percentages according to the categories required for the assignment of World Health Organization subtypes, the degree of agreement was not statistically significant for cases with 5-9% blasts in bone marrow (P=0.07), 0.1-1% blasts in peripheral blood (P=0.47), or percentage of erythroid dysplastic cells (P=0.49). Finally, the interobserver concordance for World Health Organization-defined subtypes showed a moderate overall agreement (P<0.001), the reproducibility being lower for cases with refractory anemia with excess of blasts type 1 (P=0.05) and refractory anemia with ring sideroblasts (P=0.09). In conclusion, the reproducibility of the World Health Organization 2008 classification for myelodysplastic syndromes is acceptable but the defining criteria for blast cells and features of erythroid dysplasia need to be refined.
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Affiliation(s)
- Leonor Senent
- Servicio de Hematología, Hospital Universitario La Fe, Valencia, Spain.
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13
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López Arrieta JM, De Paz R, Altés A, del Cañizo C. [Myelodysplastic syndrome in the elderly: comprehensive geriatric assessment and therapeutic recommendations]. Med Clin (Barc) 2012; 138:119.e1-9. [PMID: 22032819 DOI: 10.1016/j.medcli.2011.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 07/28/2011] [Accepted: 08/24/2011] [Indexed: 12/20/2022]
Abstract
The onset of myelodysplastic syndromes (MDS) is usually around the age of 70. Despite this, most clinical trials are restricted to younger subjects. Thus, the management of elderly patients with MDS is not always optimal. Physiologically, elderly patients show characteristics that differ from those of younger patients and that condition their pharmacological treatment. In this regard, the comprehensive geriatric assessment (CGA) becomes particularly important. This document gathers conclusions from the 1(st) Meeting of Members of the Sociedad Española de Medicina Geriátrica and the Sociedad Española de Hematología y Hemoterapia, with the objective of proposing the establishment of CGA instruments to assist in the decision-making process of elderly patients with MDS. The results of this consensus document will focus on the diagnosis, prognosis, treatment and management of adverse events in this age group.
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Suzuki S, Kurata M, Abe S, Miyazawa R, Murayama T, Hidaka M, Yamamoto K, Kitagawa M. Overexpression of MCM2 in myelodysplastic syndromes: association with bone marrow cell apoptosis and peripheral cytopenia. Exp Mol Pathol 2011; 92:160-6. [PMID: 22115939 DOI: 10.1016/j.yexmp.2011.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 11/03/2011] [Indexed: 02/03/2023]
Abstract
Myelodysplastic syndromes (MDS) are characterized by proliferation and apoptosis of bone marrow cells. Minichromosome maintenance protein (MCM) 2, which is known to be essential for regulating DNA replication, has proven to have a pro-apoptotic effect in our recent study. Thus, to determine the role of MCM2 in MDS, real-time PCR, immunohistochemistry and in vitro analysis were performed. Our results showed higher MCM2 expression in MDS than in control and AML. Notably, there was no correlation between MCM2 and Ki67-labeling indices (LIs) in MDS, while MCM2 LIs were significantly correlated with cleaved caspase 3 LIs in MDS. In vitro analysis revealed that MCM2 overexpression induced apoptosis in HL60 cells. Furthermore, MDS bone marrow exhibited higher ratio of MCM2 and cleaved caspase 3 double-positive cells and the ratio was correlated with the degree of leukocytopenia. These results suggest that the up-regulated expression of MCM2 is associated with frequent apoptosis in MDS and may have an important role in the pathogenesis of MDS.
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Affiliation(s)
- Shiho Suzuki
- Department of Comprehensive Pathology, Graduate School, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
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Hassan IS, Dar J. Systemic vasculitis with prolonged pyrexia, recurrent facial urticaria, skin nodules, pleural effusions and venous thrombosis: an unusual presentation of an uncommon disease. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2011; 9:Doc27. [PMID: 22031795 PMCID: PMC3198116 DOI: 10.3205/000150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 09/15/2011] [Indexed: 11/22/2022]
Abstract
Classically presenting with multiple or single peripheral cytopenias of variable severity, the myelodysplastic syndromes may occasionally present with bizarre manifestations that confuse the clinical picture and result in significant delays in making the correct diagnosis. We describe the case of an elderly male patient whose presentation with prolonged unexplained fever coupled with cutaneous, pulmonary and other systemic features of inflammation was finally diagnosed as having a primary myelodysplastic syndrome with associated vasculitis after a delay of 4 years.
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Affiliation(s)
- Imad Salah Hassan
- King Saud ibn Abdulaziz University for Health Sciences and the Department of Medicine 1443, King Abdulaziz Medical City, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia,*To whom correspondence should be addressed: Imad Salah Hassan, Department of Medicine 1443, King Abdulaziz Medical City, King Fahad National Guard Hospital, PO Box 22490, Riyadh 11426, Kingdom of Saudi Arabia, Tel.: 00966 56 089 4530, Fax: 966 1 2520088, Ext 14229, E-mail:
| | - Javeed Dar
- Department of Medicine 1443, King Abdulaziz Medical City, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia
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16
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Kim M, Chung S, See CJ, Yoon SS, Kim BK, Kim HK, Lee DS. Quantity of clonal cells detected by conventional cytogenetic analysis correlates with bone marrow blasts and survival in myelodysplastic syndromes. Leuk Res 2011; 36:163-8. [PMID: 21920602 DOI: 10.1016/j.leukres.2011.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 08/22/2011] [Accepted: 08/23/2011] [Indexed: 11/19/2022]
Abstract
We performed quantitative and qualitative analyses of conventional cytogenetic analysis and interphase FISH results in 87 MDS patients. The quantity of clonal cells for each chromosome of CCA did not correlate with the result of iFISH (r, range 0.0761-1.0577). The clonal cell percentage in CCA was higher in patients with >5% bone marrow blasts than those with <5% (44.7% vs. 23.1%, p=0.017). Multivariate analysis showed that a high quantity of clonal cells in CCA analysis is an independent prognostic factor for overall survival in MDS (p=0.012).
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Affiliation(s)
- Miyoung Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Jongno-gu, Seoul, South Korea
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17
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Galbraith D, Gross SA, Paustenbach D. Benzene and human health: A historical review and appraisal of associations with various diseases. Crit Rev Toxicol 2010; 40 Suppl 2:1-46. [DOI: 10.3109/10408444.2010.508162] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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18
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Harvey RD. Myelodysplastic syndromes and the role of iron overload. Am J Health Syst Pharm 2010; 67:S3-9. [PMID: 20332503 DOI: 10.2146/ajhp090645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The epidemiology of myelodysplastic syndromes (MDS) and iron overload, recent clinical findings that highlight the importance of actively managing iron overload, and recommendations for initiating and maintaining iron chelation therapy (ICT) are summarized. SUMMARY MDS are a variety of hematological disorders with differing time courses. Disease morbidities are primarily due to cytopenias and evolution to acute myeloid leukemia. Iron overload is a serious complication in patients with MDS due to the long-term use of red blood cell transfusions in patients with symptomatic anemia. Clinical consequences of iron overload include end-organ damage and dysfunction, an increased frequency of transplant-related complications, and reduced survival rates. To prevent these complications, recommendations for initiating and maintaining ICT should be followed by clinicians caring for patients with MDS and iron overload. CONCLUSION As current therapeutic options for patients with MDS do not always reduce the transfusion burden, many patients will still need long-term transfusion therapy. Strategies for the management of iron overload in MDS should be considered early in the disease course and in appropriate patients in order to prevent negative clinical outcomes associated with excessive iron accumulation.
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Affiliation(s)
- R Donald Harvey
- Department of Hematology/Medical Oncology, Emory University, Atlanta, GA 30322, USA.
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19
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Kuninaka N, Kurata M, Yamamoto K, Suzuki S, Umeda S, Kirimura S, Arai A, Nakagawa Y, Suzuki K, Kitagawa M. Expression of Toll-like receptor 9 in bone marrow cells of myelodysplastic syndromes is down-regulated during transformation to overt leukemia. Exp Mol Pathol 2010; 88:293-8. [PMID: 20132814 DOI: 10.1016/j.yexmp.2010.01.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 11/16/2009] [Accepted: 01/21/2010] [Indexed: 01/02/2023]
Abstract
Toll-like receptors (TLRs) play a crucial role in the host defense against invading microorganisms by recognizing pathogen-associated molecular patterns. Recently, a number of endogenous molecules have been reported to be ligands of TLRs. Some of these molecules are known to be expressed in cancer tissue and activate intracellular signal pathways via TLRs during cancer progression. Thus, in the present study, we analyzed the expression dynamics of TLRs in the bone marrow of myelodysplastic syndromes (MDS) during the course of transformation to overt leukemia (OL) using real-time RT-PCR. MDS bone marrow cells at the time of initial diagnosis tended to express higher levels of TLR2, TLR4 and TLR9 than control bone marrow cells. Among these TLRs, TLR9 exhibited a significant decrease of expression at the time of transformation to OL. The expression of TLR9 and TNF-alpha showed significant correlation in bone marrow cells from patients with MDS and OL. Immunohistochemically, TLR2 was mostly localized to neutrophils of the control and MDS bone marrow. TLR4 was observed in a subset of neutrophils and a few mononuclear cells in control and MDS bone marrow. In addition, TLR4 was weakly expressed in nearly half of immature myeloid cells of MDS cases. TLR9 was mainly localized to neutrophils in the control and RA bone marrow and strongly expressed in the immature myeloid cells of RAEB cases, although the blastic cells of OL cases did not express TLR9. Bone marrow cells in MDS exhibit frequent apoptosis, while OL cells are prone to be immortal. Thus, TLR9 might be associated with regulation of apoptotic/proliferative signals via TNF-alpha in the MDS bone marrow.
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Affiliation(s)
- Nobuo Kuninaka
- Department of Comprehensive Pathology, Graduate School, Tokyo Medical and Dental University, Tokyo Japan
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20
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Smoking and alcohol intake as risk factors for myelodysplastic syndromes (MDS). Leuk Res 2010; 34:1-5. [DOI: 10.1016/j.leukres.2009.08.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Revised: 08/06/2009] [Accepted: 08/07/2009] [Indexed: 11/30/2022]
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21
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Mortality Patterns and Trends Among 127,266 U.S.-Based Men in a Petroleum Company: Update 1979–2000. J Occup Environ Med 2009; 51:1333-48. [DOI: 10.1097/jom.0b013e3181be6c18] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Sperr WR, Wimazal F, Kundi M, Baumgartner C, Nösslinger T, Makrai A, Stauder R, Krieger O, Pfeilstöcker M, Valent P. Comorbidity as prognostic variable in MDS: comparative evaluation of the HCT-CI and CCI in a core dataset of 419 patients of the Austrian MDS Study Group. Ann Oncol 2009; 21:114-9. [PMID: 19605505 DOI: 10.1093/annonc/mdp258] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The evaluation of comorbidity is of increasing importance in patients with hematologic disorders. PATIENTS AND METHODS In the present study, the influence of comorbidity on survival and acute myeloid leukemia (AML) evolution was analyzed retrospectively in 419 patients with de novo myelodysplastic syndromes (MDS) (observation period: 1985-2007). The median age was 71 years (range 24-91 years). Two different scoring systems, the hematopoietic stem-cell transplantation-specific comorbidity index (HCT-CI) and the Charlson comorbidity index (CCI) were applied. RESULTS The HCT-CI was found to be a significant prognostic factor for overall survival (OS, P < 0.05) as well as event-free survival (EFS, P < 0.05) in our patients, whereas the CCI was of prognostic significance for OS (P < 0.05), but not for EFS. For AML-free survival, neither the HCT-CI nor the CCI were of predictive value. A multivariate analysis including age, lactate dehydrogenase, ferritin, karyotype, number of cytopenias, French-American-British groups, and comorbidity was applied. Comorbidity was found to be an independent prognostic factor in patients with low- or int-1-risk MDS (P < 0.05) regarding OS and EFS. CONCLUSIONS Together, our data show that comorbidity is an important risk factor for OS and EFS in patients with MDS.
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Affiliation(s)
- W R Sperr
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, A-1090 Vienna, Austria.
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23
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Demirkan F, Alacacioglu I, Piskin O, Ozsan HG, Akinci B, Ozcan AM, Yavuzsen T, Yuksel E, Undar B. The clinical, haematological and morphological profile of patients with myelodysplastic syndromes: A single institution experience from Turkey. Leuk Lymphoma 2009; 48:1372-8. [PMID: 17613766 DOI: 10.1080/10428190701377063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In a retrospective analysis of 113 patients with primary myelodysplastic syndromes (MDS) diagnosed according to French-American-British (FAB) classification, we evaluated the prognostic impact of FAB and World Health Organisation (WHO) classifications, International Prognostic Scoring System (IPSS), and other clinical and laboratory variables. The median age was 69. IPSS could be applied to 75 patients classified according to the FAB criteria and to 50 patients reclassified according to the WHO criteria. At a median follow-up of 24 months, 22 patients (19.5 %) transformed to acute myelogenous leukaemia (AML). Overall survival (OS) of patients differed significantly between the FAB and WHO subgroups (p < 0.0001). In WHO classification, significant differences were observed in both OS and leukaemia free survival (LFS) between patients with RA/RARS and refractory cytopenia with multi-lineage dysplasia/refractory cytopenia with multi-lineage dysplasia and ringed sideroblasts (RCMD/RS-RCMD) (p = 0.0001). High-risk according to IPSS score and blood transfusion need were significantly predictive for a shorter survival and higher risk of transformation. Hemoglobin <10 g/dl, neutrophil count <0.5 x 10(9)/L, platelet count <50 x 10(9)/L had an unfavourable prognostic impact on survival in multi-variate analysis. Our conclusions support the previous findings on the value of WHO classification for prediction of prognosis in MDS.
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Affiliation(s)
- Fatih Demirkan
- Division of Hematology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
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24
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Cutaneous leukocytoclastic vasculitis and myelodysplastic syndrome with little or no evidence of associated autoimmune disorders-a case report and a brief review of the literature. Am J Med Sci 2008; 336:368-71. [PMID: 18854686 DOI: 10.1097/maj.0b013e31815e8c0b] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cutaneous leukocytoclastic vasculitis (CLV) is a necrotizing inflammatory disease of the small vessels in the dermis. Approximately 50% of cases with CLV are primary or idiopathic and the remainder may be associated with various diseases. Less than 1% CLV occurs in association with malignancies including leukemia, lymphoma, and myelodysplastic syndrome (MDS). The pathogenetic mechanism of CLV remains speculative and is generally believed to be related to autoimmune processes. We report here a 77-year-old white woman who presented with contemporaneous occurrence of CLV and MDS (WHO subtype RAEB-2). Autoantibodies and immune-complexes were not detected either in the serum or by direct immunofluorescense in the skin biopsy. The clinical course of MDS remained steady, but the cutaneous lesion resolved within 2 weeks with minimal or no specific therapy except corticosteroids. We suggest that absence of autoimmune phenomena and immune-complex in the skin lesions of CLV may be a hallmark of good prognosis.
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25
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Wang SA, Tang G, Fadare O, Hao S, Raza A, Woda BA, Hasserjian RP. Erythroid-predominant myelodysplastic syndromes: enumeration of blasts from nonerythroid rather than total marrow cells provides superior risk stratification. Mod Pathol 2008; 21:1394-402. [PMID: 18839018 DOI: 10.1038/modpathol.2008.142] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In the FAB (French-American-British) and WHO (World Heath Organization) classifications, the blasts in erythroleukemia (M6a) are enumerated from the marrow nonerythroid rather than the total-nucleated cells. However, the method for blast calculation in erythroid-predominant myelodysplastic syndrome (erythroblasts>or=50%) is not specified either in the FAB or WHO classifications. We retrieved the files of 74 erythroid-predominant myelodysplastic syndrome patients (17% of all myelodysplastic syndrome) and 192 myelodysplastic syndrome controls (erythroblasts<50%). In erythroid-predominant myelodysplastic syndrome, by enumerating blasts from marrow nonerythroid cells rather than from total nucleated cells, 41 of 74 (55%) cases would be upgraded, either by disease subcategory or International Prognostic Scoring System. Importantly, the patients with <5% blasts demonstrated a superior survival to patients with >or=5% blasts (P=0.002); this distinction was lost when blasts were calculated from total-nucleated cells. Of cases with >or=5% blasts, cytogenetics rather than blast count correlated with survival. We conclude that in erythroid-predominant myelodysplastic syndrome, blast calculation as a proportion of marrow nonerythroid rather than total nucleated cells can better stratify patients into prognostically relevant groups.
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Affiliation(s)
- Sa A Wang
- Department of Pathology, UMass Memorial Medical Center, University of Massachusetts, Worcester, MA, USA.
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26
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International Working Group on MDS cytogenetics: October 2007 meeting report. Leuk Res 2008; 32:1329-32. [DOI: 10.1016/j.leukres.2008.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 03/05/2008] [Accepted: 03/10/2008] [Indexed: 11/15/2022]
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27
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Chee CE, Steensma DP, Wu W, Hanson CA, Tefferi A. Neither serum ferritin nor the number of red blood cell transfusions affect overall survival in refractory anemia with ringed sideroblasts. Am J Hematol 2008; 83:611-3. [PMID: 18442062 DOI: 10.1002/ajh.21192] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In a retrospective study of 126 adult patients with French-American-British-defined refractory anemia with ringed sideroblasts (RARS), staging by the International Prognostic Scoring System was highly predictive of survival outcome (P < 0.0001). In addition, red blood cell (RBC) transfusion requirement at diagnosis (P = 0.001), but not the number of RBC units transfused during the disease course (P = 0.17), was independently associated with inferior survival. There were no correlations between survival and serum ferritin level, measured either at diagnosis (median 567 ng/mL, range 16-3,475; P = 0.24) or during follow-up (median 1,108 ng/mL; range 238-43,500; P = 0.72). Similarly, there was no difference in survival when patients were stratified by serum ferritin levels of < or > or =1,000 ng/mL at diagnosis or peak serum ferritin levels of <1,000, 1,000-5,000, or >5,000 ng/mL during follow-up. The current study does not support the contention that transfusional hemosiderosis is an adverse prognostic factor in "good risk" myelodysplastic syndrome.
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Affiliation(s)
- Cheng E Chee
- Division of Hematology, Mayo Clinic, Rochester, Minnesota 55905, USA
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28
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Neumann F, Gattermann N, Barthelmes HU, Haas R, Germing U. Levels of beta 2 microglobulin have a prognostic relevance for patients with myelodysplastic syndrome with regard to survival and the risk of transformation into acute myelogenous leukemia. Leuk Res 2008; 33:232-6. [PMID: 18639338 DOI: 10.1016/j.leukres.2008.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 06/02/2008] [Accepted: 06/03/2008] [Indexed: 10/21/2022]
Abstract
We evaluated the relevance of beta 2 microglobulin (B2M) plasma concentration in 109 patients with myelodysplastic syndrome (MDS) from the Duesseldorf registry. Sixty-five patients with B2M level > or =2mg/dl showed a significantly lower overall survival time with a median of 23 in comparison to 61 months for 44 patients with B2M below 2mg/dl. The risk of AML evolution was higher in patients with B2M> or =2mg/dl. Using multivariate analysis we found the B2M level at the time of diagnosis to be an independent prognostic parameter for survival and for the risk of developing AML in high-risk MDS patients.
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Affiliation(s)
- Frank Neumann
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany.
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29
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Wimazal F, Sperr W, Kundi M, Vales A, Fonatsch C, Thalhammer-Scherrer R, Schwarzinger I, Valent P. Prognostic significance of serial determinations of lactate dehydrogenase (LDH) in the follow-up of patients with myelodysplastic syndromes. Ann Oncol 2008; 19:970-6. [DOI: 10.1093/annonc/mdm595] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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30
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Savage SA, Alter BP. The role of telomere biology in bone marrow failure and other disorders. Mech Ageing Dev 2007; 129:35-47. [PMID: 18160098 DOI: 10.1016/j.mad.2007.11.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Revised: 11/07/2007] [Accepted: 11/10/2007] [Indexed: 10/22/2022]
Abstract
Telomeres, consisting of nucleotide repeats and a protein complex at chromosome ends, are essential in maintaining chromosomal integrity. Dyskeratosis congenita (DC) is the inherited bone marrow failure syndrome (IBMFS) that epitomizes the effects of abnormal telomere biology. Patients with DC have extremely short telomere lengths (<1st percentile) and many have mutations in telomere biology genes. Interpretation of telomere length in other IBMFSs is less straightforward. Abnormal telomere shortening has been reported in patients with apparently acquired hematologic disorders, including aplastic anemia, myeolodysplasia, paroxysmal nocturnal hemoglobinuria, and leukemia. In these disorders, the shortest-lived cells have the shortest telomeres, suggestive of increased hematopoietic stress. Telomeres are also markers of replicative and/or oxidative stress in other complex disease pathways, such as inflammation, stress, and carcinogenesis. The spectrum of related disorders caused by mutations in telomere biology genes extends beyond classical DC to include marrow failure that does not respond to immunosuppression, idiopathic pulmonary fibrosis, and possibly other syndromes. We suggest that such patients be categorized as having an inherited disorder of telomere biology. Longitudinal studies of patients with very short telomeres but without classical DC are necessary to further understand the long-term sequelae, such as malignancy, osteonecrosis/osteoporosis, and pulmonary and liver disease.
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Affiliation(s)
- Sharon A Savage
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20892, United States.
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31
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Maratheftis CI, Bolaraki PE, Voulgarelis M. GATA-1 transcription factor is up-regulated in bone marrow hematopoietic progenitor CD34(+) and erythroid CD71(+) cells in myelodysplastic syndromes. Am J Hematol 2007; 82:887-92. [PMID: 17570514 DOI: 10.1002/ajh.20993] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
GATA-1 is a transcription factor governing the production of erythroid and megakaryocytic cells. Unobstructed GATA-1 expression in early progenitor cells commits them to the myeloid lineage, channeling its differentiation towards erythrocytes and megakaryocytes. Myelodysplastic Syndromes (MDS) are clonal disorders of the hematopoietic stem cell frequently presenting dysplasia in erythroid and/or megakaryocytic lineage. We reasoned that measurement of GATA-1 expression levels in hematopoietic progenitor CD34(+) and the committed erythroid CD71(+) cells, from various MDS subcategories, could demonstrate GATA-1 involvement in the pathogenesis of the syndrome. In this study, MDS patients displayed significantly elevated GATA-1 mRNA expression, in bone marrow mononuclear cells (BMMCs), progenitor CD34(+) and erythroid CD71(+) cells in contrast to the control population (P < 0.001). Additionally, GATA-1 mRNA expression in MDS CD71(+) cells was positively correlated with their apoptotic levels (rho = 0.58, P = 0.03). Furthermore, GATA-1 expression levels were found to correlate with the disease progression. MDS patients in high/INT-2 IPSS risk group expressed significantly higher GATA-1 mRNA levels, in both CD34(+) and CD71(+) cells, as opposed to low/INT-1 patients (P < 0.001). Moreover, the former displayed increased apoptosis in the CD71(+) cells and significantly reduced neutrophil and platelet numbers and hemoglobin levels compared with the latter. We conclude that MDS patients display an increase of GATA-1 mRNA expression in BM cells, with high/INT-2 patients showing significantly higher levels. The higher level of GATA-1 mRNA in erythroid cells was positively correlated with their degree of apoptosis. These findings suggest that the up-regulation of GATA-1 may be responsible for the peripheral cytopenias in MDS.
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MESH Headings
- Aged
- Aged, 80 and over
- Anemia, Iron-Deficiency/metabolism
- Anemia, Iron-Deficiency/pathology
- Antigens, CD/analysis
- Antigens, CD34/analysis
- Apoptosis
- Blood Cell Count
- Bone Marrow/pathology
- Disease Progression
- Erythroid Precursor Cells/metabolism
- Erythroid Precursor Cells/pathology
- Female
- GATA1 Transcription Factor/biosynthesis
- GATA1 Transcription Factor/genetics
- Hematopoietic Stem Cells/metabolism
- Hemoglobins/analysis
- Humans
- Lupus Erythematosus, Systemic/metabolism
- Lupus Erythematosus, Systemic/pathology
- Male
- Middle Aged
- Monocytes/metabolism
- Myelodysplastic Syndromes/etiology
- Myelodysplastic Syndromes/metabolism
- Myelodysplastic Syndromes/pathology
- RNA, Messenger/biosynthesis
- RNA, Messenger/genetics
- Receptors, Transferrin/analysis
- Risk
- Up-Regulation
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32
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Tefferi A, Vardiman JW. Classification and diagnosis of myeloproliferative neoplasms: the 2008 World Health Organization criteria and point-of-care diagnostic algorithms. Leukemia 2007; 22:14-22. [PMID: 17882280 DOI: 10.1038/sj.leu.2404955] [Citation(s) in RCA: 766] [Impact Index Per Article: 45.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The 2001 World Health Organization (WHO) treatise on the classification of hematopoietic tumors lists chronic myeloproliferative diseases (CMPDs) as a subdivision of myeloid neoplasms that includes the four classic myeloproliferative disorders (MPDs)-chronic myelogenous leukemia, polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF)-as well as chronic neutrophilic leukemia (CNL), chronic eosinophilic leukemia/hypereosinophilic syndrome (CEL/HES) and 'CMPD, unclassifiable'. In the upcoming 4th edition of the WHO document, due out in 2008, the term 'CMPDs' is replaced by 'myeloproliferative neoplasms (MPNs)', and the MPN category now includes mast cell disease (MCD), in addition to the other subcategories mentioned above. At the same time, however, myeloid neoplasms with molecularly characterized clonal eosinophilia, previously classified under CEL/HES, are now removed from the MPN section and assembled into a new category of their own. The WHO diagnostic criteria for both the classic BCR-ABL-negative MPDs (that is PV, ET and PMF) and CEL/HES have also been revised, in the 2008 edition, by incorporating new information on their molecular pathogenesis. The current review highlights these changes and also provides diagnostic algorithms that are tailored to routine clinical practice.
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Affiliation(s)
- A Tefferi
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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33
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Horny HP, Sotlar K, Valent P. Diagnostic value of histology and immunohistochemistry in myelodysplastic syndromes. Leuk Res 2007; 31:1609-16. [PMID: 17604834 DOI: 10.1016/j.leukres.2007.05.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Revised: 05/07/2007] [Accepted: 05/08/2007] [Indexed: 10/23/2022]
Abstract
The histologic and immunohistochemical analysis of the bone marrow yields important information for the diagnosis of myelodysplastic syndromes (MDS), thereby often exceeding the information obtained by cytological analysis of smears. Notably, tissue-fibrosis, angiogenesis, or the abnormal localization of megakaryocytes and CD34+ progenitor cells can only be assessed histologically. Many of these parameters are also of prognostic significance. Moreover, evaluation of bone marrow histology is of crucial importance in cases with dry-tap or blood-contaminated marrow-smears, especially in hypoplastic states. Histologic/immunohistochemical investigation of the bone marrow therefore is strongly recommended for patients with (suspected) MDS, the minimum marker-panel suggested being CD31, CD34, and tryptase.
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34
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Perkins SL, Reddy VBV, Reichard KK, Thompsen MA, Dunphy CH. Recommended curriculum for teaching hematopathology to subspecialty hematopathology fellows. Am J Clin Pathol 2007; 127:962-76. [PMID: 17509994 DOI: 10.1309/6c41q30m5rm83qmh] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The performance and interpretation of clinical hematology and hematopathology laboratory tests and diagnosis of benign or malignant hematolymphoid disorders present unique challenges to hematopathology fellow trainees. To assist hematopathology fellowship program directors in preparing trainees to meet these challenges, a task force of pathologists with expertise in hematopathology developed a suggested training curriculum that includes a comprehensive list of topics in the areas of analytic hematology, bone marrow pathology, lymph node pathology, splenic pathology, lymphoma diagnostics, cytogenetics, and molecular diagnostics. This report also includes recommendations for training experiences that will facilitate the transition of subspecialty residents to practicing consultants in hematopathology.
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Affiliation(s)
- Sherrie L Perkins
- Department of Pathology, University of Utah, Salt Lake City , UT 84132, USA
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35
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Bernasconi P, Klersy C, Boni M, Cavigliano PM, Calatroni S, Giardini I, Rocca B, Zappatore R, Caresana M, Dambruoso I, Lazzarino M, Bernasconi C. World Health Organization classification in combination with cytogenetic markers improves the prognostic stratification of patients with de novo primary myelodysplastic syndromes. Br J Haematol 2007; 137:193-205. [PMID: 17408458 DOI: 10.1111/j.1365-2141.2007.06537.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study correlated chromosomal defects with French-American-British (FAB)/World Health Organization (WHO) classification subtypes, proposed a revised International Prognostic Scoring System (IPSS) cytogenetic grouping; and established which classification, when used with the IPSS cytogenetic categories, best predicted clinical outcome in the myelodysplastic syndromes (MDS). A higher prevalence of chromosomal defects and distinct defects were observed in patients with multi-lineage dysplasia and a blast cell percentage >10%. Abnormalities of the long arm of chromosome 3, del(7)(q31q35), trisomy 8, del(11)(q14q23), del(12p) and 20q- could be segregated from their respective IPSS cytogenetic categories and used to develop new cytogenetic subgroups. Clinical parameters, FAB/WHO classification, IPSS score and standard or revised cytogenetic categories were statistically relevant for overall survival (OS) and progression-free intervals (PFI) and were included within five distinct multivariate models compared by the Akaike Information Criterion. To predict OS, the best models included age, WHO classification and standard or revised IPSS cytogenetic categories; to predict PFI, the best model included the same variables and revised cytogenetic categories. In conclusion, (i) the WHO classification was associated with a more homogeneous cytogenetic pattern than the FAB classification, (ii) WHO classification and standard/revised IPSS cytogenetic categories were much more effective than IPSS for predicting MDS clinical outcome, (iii) revised cytogenetic subgroups predicted PFI more effectively than standard categories.
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MESH Headings
- Adult
- Aged
- Chromosome Aberrations
- Chromosome Deletion
- Chromosomes, Human/genetics
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 12/genetics
- Chromosomes, Human, Pair 20/genetics
- Chromosomes, Human, Pair 3/genetics
- Chromosomes, Human, Pair 7/genetics
- Chromosomes, Human, Pair 8/genetics
- Cytogenetic Analysis/methods
- Disease Progression
- Female
- Humans
- Karyotyping/methods
- Male
- Middle Aged
- Myelodysplastic Syndromes/classification
- Myelodysplastic Syndromes/genetics
- Myelodysplastic Syndromes/therapy
- Prognosis
- Trisomy/genetics
- World Health Organization
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Affiliation(s)
- Paolo Bernasconi
- Division of Haematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
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Maratheftis CI, Andreakos E, Moutsopoulos HM, Voulgarelis M. Toll-like Receptor-4 Is Up-Regulated in Hematopoietic Progenitor Cells and Contributes to Increased Apoptosis in Myelodysplastic Syndromes. Clin Cancer Res 2007; 13:1154-60. [PMID: 17317824 DOI: 10.1158/1078-0432.ccr-06-2108] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To investigate the function and expression of Toll-like receptors (TLR) in bone marrow cells of myelodysplastic syndrome (MDS) patients and to examine their involvement in the apoptotic phenomenon characterizing MDS hematopoiesis. EXPERIMENTAL DESIGN TLR mRNA and protein expression was investigated in bone marrow cell populations of MDS patients and controls. TLR-4 ability to recognize lipopolysaccharide and up-regulate self mRNA and protein expression was examined. Tumor necrosis factor involvement in the constitutive and lipopolysaccharide (LPS)-induced TLR expression was also evaluated. Possible correlation between TLR-4 overexpression and apoptosis was investigated by simultaneous staining with Annexin V and TLR-4. RESULTS TLR-2 and TLR-4 are expressed in almost all bone marrow cell lineages including megakaryocytes, erythroid cells, myeloid precursors, monocytes, and B lymphocytes and are up-regulated in MDS patients compared with controls. In hematopoietic CD34(+) cells, TLR-4 is also expressed and significantly up-regulated at both the mRNA and protein levels. Treatment with an anti-tumor necrosis factor antibody reduces both constitutive and LPS-induced TLR-4 levels. Increased TLR-4 expression correlates with increased apoptosis as TLR-4 is almost exclusively found in apoptotic bone marrow mononuclear and CD34(+) cells. The addition of the TLR-4 ligand LPS further enhances the apoptosis of these cells. CONCLUSIONS TLR-4 and other TLRs are significantly up-regulated in MDS patients whereas TLR-4 is involved in promoting apoptosis, possibly contributing to MDS cytopenia.
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Valent P, Horny HP, Bennett JM, Fonatsch C, Germing U, Greenberg P, Haferlach T, Haase D, Kolb HJ, Krieger O, Loken M, van de Loosdrecht A, Ogata K, Orfao A, Pfeilstöcker M, Rüter B, Sperr WR, Stauder R, Wells DA. Definitions and standards in the diagnosis and treatment of the myelodysplastic syndromes: Consensus statements and report from a working conference. Leuk Res 2007; 31:727-36. [PMID: 17257673 DOI: 10.1016/j.leukres.2006.11.009] [Citation(s) in RCA: 376] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Revised: 11/14/2006] [Accepted: 11/14/2006] [Indexed: 11/29/2022]
Abstract
The classification, scoring systems, and response criteria for myelodysplastic syndromes (MDS) have recently been updated and have become widely accepted. In addition, several new effective targeted drugs for patients with MDS have been developed. The current article provides a summary of updated and newly proposed markers, criteria, and standards in MDS, with special reference to the diagnostic interface and refinements in evaluations and scoring. Concerning the diagnostic interface, minimal diagnostic criteria for MDS are proposed, and for patients with unexplained cytopenia who do not fulfill these criteria, the term 'idiopathic cytopenia of uncertain significance' (ICUS) is suggested. In addition, new diagnostic and prognostic parameters, histopathologic and immunologic determinants, proposed refinements in scoring systems, and new therapeutic approaches are discussed. Respective algorithms and recommendations should facilitate diagnostic and prognostic evaluations in MDS, selection of patients for therapies, and the conduct of clinical trials.
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Affiliation(s)
- Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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Haferlach T, Bacher U, Kern W, Schnittger S, Gassmann W, Haferlach C. A comprehensive approach to the diagnosis of MDS after triage by morphology towards cytogenetics and other techniques. Cancer Treat Rev 2007. [DOI: 10.1016/j.ctrv.2007.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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39
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Kiratli H, Bilgiç S, Emeç S. Conjunctival infiltration as the first sign of acute myelomonocytic (M4) leukemia in a 2-year-old child. J AAPOS 2006; 10:375-6. [PMID: 16935242 DOI: 10.1016/j.jaapos.2006.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2005] [Accepted: 02/10/2006] [Indexed: 11/30/2022]
Affiliation(s)
- Hayyam Kiratli
- Ocular Oncology Service, Department of Ophthalmology, Hacettepe University School of Medicine, Sihhiye 06100, Ankara, Turkey.
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Ogata K, Kishikawa Y, Satoh C, Tamura H, Dan K, Hayashi A. Diagnostic application of flow cytometric characteristics of CD34+ cells in low-grade myelodysplastic syndromes. Blood 2006; 108:1037-44. [PMID: 16574954 DOI: 10.1182/blood-2005-12-4916] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The diagnosis of myelodysplastic syndromes (MDS) without an increase in blasts and ringed sideroblasts (low-grade MDS without ringed sideroblasts [LGw/oRS]) may be problematic because dysplastic features are not specific to MDS and approximately 50% of patients with LGw/oRS lack chromosomal aberrations. Here, we report the usefulness of flow cytometric characteristics of CD34(+) cells for LGw/oRS diagnosis. Bone marrow cells from LGw/oRS patients and controls (eg, cytopenic individuals without MDS) were analyzed using 4-color flow cytometry (FCM). We objectively determined reference ranges of 13 parameters related to CD34(+) cells with data from controls. In LGw/oRS patients, various abnormalities of CD34(+) cells-eg, decrease in CD34(+) B-cell precursors, aberrant expression or overexpression of various antigens on CD34(+) myeloblasts-were observed. We constructed a reproducible, flow cytometric scoring system for LGw/oRS diagnosis. High scores were observed in 16 of 27 LGw/oRS patients, regardless of the presence or absence of chromosomal aberrations, but not in any of the 90 controls. Among LGw/oRS patients with chromosomal aberrations, patients with trisomy 8 or del20(q) had low FCM scores (P = .002). As a result, most LGw/oRS patients were identified based on high FCM score, chromosomal aberration, or both.
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Affiliation(s)
- Kiyoyuki Ogata
- Division of Hematology, Nippon Medical School, 1-1-5 Sendagi, Tokyo 113-8603, Japan.
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Steensma DP. Are myelodysplastic syndromes "cancer"? Unexpected adverse consequences of linguistic ambiguity. Leuk Res 2006; 30:1227-33. [PMID: 16443272 DOI: 10.1016/j.leukres.2005.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2005] [Revised: 12/04/2005] [Accepted: 12/04/2005] [Indexed: 01/20/2023]
Abstract
Myelodysplastic syndromes (MDS) are clonal, neoplastic disorders of hematopoietic tissue that convey a guarded prognosis, but physicians vary in whether they refer to MDS as a "cancer" when discussing the diagnosis with patients. Because of past ambiguity about whether MDS is truly a malignancy, confusion about MDS terminology is widespread. Additionally, patients who carry one of the dubious cancer-specific health insurance policies are usually not eligible for financial benefits when they receive a diagnosis of MDS. Likewise, patients with MDS who have been led to believe they do not have a form of cancer by their primary physician may become upset when seeing another health care provider who does refer to MDS in this way. Here, I discuss evidence supporting broader consideration of MDS as a form of malignant neoplasia - i.e., cancer - as well as some of the relevant practical issues.
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Affiliation(s)
- David P Steensma
- Department of Medicine (Hematology) and Oncology, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Current Awareness in Hematological Oncology. Hematol Oncol 2005. [DOI: 10.1002/hon.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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