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Zhang Y, Li W, Liang Y, Liu Y, Dai W. Diagnostic Value of CD34 and CD117 Immunohistochemistry and Megakaryocyte Morphology in Myelodysplastic Syndromes: A Retrospective Case-control Study. Appl Immunohistochem Mol Morphol 2024; 32:125-129. [PMID: 38053414 DOI: 10.1097/pai.0000000000001177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/12/2023] [Indexed: 12/07/2023]
Abstract
This study evaluated the diagnostic value of CD34 and CD117 immunohistochemistry(IHC) and megakaryocyte morphology in Myelodysplastic syndromes (MDS). In this study, CD34-positive individual cells (Type I) and small clusters (Type II) were observed in most cases (91.2%). Type II CD34-positive was seen in 24 (49%) MDS cases, and positive percentage was higher than in acute myelogenous leukemia (AML) or aplastic anemia (AA). Type II CD117-positive were observed in 44 (89.8%) MDS cases and Type I were observed in 5 (10.2%) MDS. Type II CD117-positive percentage was higher than in AML or AA. Megakaryocyte counts were normal or increased in most MDS cases except one. Although megakaryocyte counts of AML and AA were predominantly decreased, Most MDS patients (81.6%) had abnormal megakaryocyte, whereas almost none of megakaryocyte abnormality was found in AML and AA. In conclusion, combined detection of CD34 and CD117 and observation of megakaryocyte count and morphology are useful for the diagnosis of MDS.
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Affiliation(s)
- Ying Zhang
- Department of Pathology, Liuzhou People's Hospital
| | - Wenhua Li
- Department of Pathology, Liuzhou Worker's Hospital, Liuzhou, People's Republic of China
| | | | - Youli Liu
- Department of Pathology, Liuzhou People's Hospital
| | - Wenbin Dai
- Department of Pathology, Liuzhou People's Hospital
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2
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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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3
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Delrue C, Speeckaert R, Oyaert M, Kerre T, Rottey S, Coopman R, Huvenne W, De Bruyne S, Speeckaert MM. Infrared Spectroscopy: A New Frontier in Hematological Disease Diagnosis. Int J Mol Sci 2023; 24:17007. [PMID: 38069330 PMCID: PMC10707114 DOI: 10.3390/ijms242317007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
Hematological diseases, due to their complex nature and diverse manifestations, pose significant diagnostic challenges in healthcare. The pressing need for early and accurate diagnosis has driven the exploration of novel diagnostic techniques. Infrared (IR) spectroscopy, renowned for its noninvasive, rapid, and cost-effective characteristics, has emerged as a promising adjunct in hematological diagnostics. This review delves into the transformative role of IR spectroscopy and highlights its applications in detecting and diagnosing various blood-related ailments. We discuss groundbreaking research findings and real-world applications while providing a balanced view of the potential and limitations of the technique. By integrating advanced technology with clinical needs, we offer insights into how IR spectroscopy may herald a new era of hematological disease diagnosis.
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Affiliation(s)
- Charlotte Delrue
- Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium;
| | | | - Matthijs Oyaert
- Department of Clinical Biology, Ghent University Hospital, 9000 Ghent, Belgium; (M.O.); (S.D.B.)
| | - Tessa Kerre
- Department of Hematology, Ghent University Hospital, 9000 Ghent, Belgium;
| | - Sylvie Rottey
- Department of Medical Oncology, Ghent University Hospital, 9000 Ghent, Belgium;
| | - Renaat Coopman
- Department of Oral, Maxillofacial and Plastic Surgery, Ghent University Hospital, 9000 Ghent, Belgium;
| | - Wouter Huvenne
- Department of Head and Neck Surgery, Ghent University Hospital, 9000 Ghent, Belgium;
| | - Sander De Bruyne
- Department of Clinical Biology, Ghent University Hospital, 9000 Ghent, Belgium; (M.O.); (S.D.B.)
| | - Marijn M. Speeckaert
- Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium;
- Research Foundation-Flanders (FWO), 1000 Brussels, Belgium
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4
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van der Velden VHJ, Preijers F, Johansson U, Westers TM, Dunlop A, Porwit A, Béné MC, Valent P, Te Marvelde J, Wagner-Ballon O, Oelschlaegel U, Saft L, Kordasti S, Ireland R, Cremers E, Alhan C, Duetz C, Hobo W, Chapuis N, Fontenay M, Bettelheim P, Eidenshink-Brodersen L, Font P, Loken MR, Matarraz S, Ogata K, Orfao A, Psarra K, Subirá D, Wells DA, Della Porta MG, Burbury K, Bellos F, Weiß E, Kern W, van de Loosdrecht A. Flow cytometric analysis of myelodysplasia: Pre-analytical and technical issues-Recommendations from the European LeukemiaNet. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2023; 104:15-26. [PMID: 34894176 PMCID: PMC10078694 DOI: 10.1002/cyto.b.22046] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/18/2021] [Accepted: 11/29/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Flow cytometry (FCM) aids the diagnosis and prognostic stratification of patients with suspected or confirmed myelodysplastic syndrome (MDS). Over the past few years, significant progress has been made in the FCM field concerning technical issues (including software and hardware) and pre-analytical procedures. METHODS Recommendations are made based on the data and expert discussions generated from 13 yearly meetings of the European LeukemiaNet international MDS Flow working group. RESULTS We report here on the experiences and recommendations concerning (1) the optimal methods of sample processing and handling, (2) antibody panels and fluorochromes, and (3) current hardware technologies. CONCLUSIONS These recommendations will support and facilitate the appropriate application of FCM assays in the diagnostic workup of MDS patients. Further standardization and harmonization will be required to integrate FCM in MDS diagnostic evaluations in daily practice.
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Affiliation(s)
- Vincent H J van der Velden
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank Preijers
- Department of Laboratory Medicine - Laboratory for Hematology, Radboudumc, Nijmegen, The Netherlands
| | - Ulrika Johansson
- Laboratory Medicine, SI-HMDS, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Theresia M Westers
- Department of Hematology, Amsterdam UMC, location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Alan Dunlop
- Department of Haemato-Oncology, Royal Marsden Hospital, Sutton, Surrey, UK
| | - Anna Porwit
- Department of Clinical Sciences, Division of Oncology And Pathology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Marie C Béné
- Hematology Biology, Nantes University Hospital and CRCINA, Nantes, France
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Jeroen Te Marvelde
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Orianne Wagner-Ballon
- Department of Hematology and Immunology; and Université Paris-Est Créteil, Assistance Publique-Hôpitaux de Paris, University Hospital Henri Mondor, Inserm U955, Créteil, France
| | - Uta Oelschlaegel
- Department of Internal Medicine, University Hospital Carl-Gustav-Carus, Dresden, TU, Germany
| | - Leonie Saft
- Department of Clinical Pathology and Oncology, Karolinska University Hospital and Institute, Solna, Stockholm, Sweden
| | - Sharham Kordasti
- Comprehensive Cancer Centre, King's College London and Hematology Department, Guy's Hospital, London, UK
| | - Robin Ireland
- Comprehensive Cancer Centre, King's College London and Hematology Department, Guy's Hospital, London, UK
| | - Eline Cremers
- Department of Internal Medicine, Division of Hematology, Maastricht University Medical Center, AZ, Maastricht, The Netherlands
| | - Canan Alhan
- Department of Hematology, Amsterdam UMC, location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Carolien Duetz
- Department of Hematology, Amsterdam UMC, location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Willemijn Hobo
- Department of Laboratory Medicine - Laboratory for Hematology, Radboudumc, Nijmegen, The Netherlands
| | - Nicolas Chapuis
- Assistance Publique-Hôpitaux de Paris. Centre-Université de Paris, Cochin Hospital, Laboratory of Hematology and Université de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France
| | - Michaela Fontenay
- Assistance Publique-Hôpitaux de Paris. Centre-Université de Paris, Cochin Hospital, Laboratory of Hematology and Université de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France
| | - Peter Bettelheim
- Department of Internal Medicine, Ordensklinikum Linz Barmherzige Schwestern - Elisabethinen, Linz, Austria
| | | | - Patricia Font
- Department of Hematology, Hospital General Universitario Gregorio Marañon-IiSGM, Madrid, Spain
| | | | - Sergio Matarraz
- Cancer Research Center (IBMCC, USAL-CSIC), Department of Medicine and Cytometry Service, University of Salamanca, Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Biomedical Research Networking Centre Consortium of Oncology (CIBERONC), Instituto Carlos III, Salamanca, Spain
| | - Kiyoyuki Ogata
- Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Alberto Orfao
- Cancer Research Center (IBMCC, USAL-CSIC), Department of Medicine and Cytometry Service, University of Salamanca, Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Biomedical Research Networking Centre Consortium of Oncology (CIBERONC), Instituto Carlos III, Salamanca, Spain
| | - Katherina Psarra
- Immunology Histocompatibility Department, Evangelismos Hospital, Athens, Greece
| | - Dolores Subirá
- Flow Cytometry Unit. Department of Hematology, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | - Matteo G Della Porta
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy & Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Kate Burbury
- Department of Haematology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | | | | | | | - Arjan van de Loosdrecht
- Department of Hematology, Amsterdam UMC, location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
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Volpe VO, Garcia-Manero G, Komrokji RS. Myelodysplastic Syndromes: A New Decade. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 22:1-16. [PMID: 34544674 DOI: 10.1016/j.clml.2021.07.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
Myelodysplastic syndromes (MDS) are a group of heterogeneous clonal hematopoietic stem cell disorders. The 2020 Surveillance, Epidemiology, and End Results data demonstrates the incidence rate of MDS increases with age especially in those greater than 70 years of age. Risk stratification that impact prognosis, survival, and rate of acute myeloid leukemia (AML) transformation in MDS is largely dependent on revised International Prognostic Scoring System along with molecular genetic testing as a supplement. Low risk MDS typically have a more indolent disease course in which treatment is only initiated to ameliorate symptoms of cytopenias. In many, anemia is the most common cytopenia requiring treatment and erythroid stimulating agents, are considered first line. In contrast, high risk MDS tend to behave more aggressively for which treatment should be initiated rapidly with Hypomethylating Agents (HMA) being in the frontline. In those with high risk MDS and eligible, evaluation for allogeneic stem cell transplant should be considered as this is the only potential curative option for MDS. With the use of molecular genetic testing, a personalized approach to therapy in MDS has ensued. As the treatment landscape in MDS continues to flourish with novel targeted agents, we ambitiously seek to improve survival rates especially among the relapsed/refractory and transplant ineligible.
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Affiliation(s)
- Virginia O Volpe
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL
| | | | - Rami S Komrokji
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL.
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6
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Chen P, Wang Y, Fang X, Wang X, Wang G. Prognostic significance of peritumoral fibrosis after resection of pancreatic head cancer. Oncol Lett 2020; 19:1235-1240. [PMID: 32002027 PMCID: PMC6960382 DOI: 10.3892/ol.2019.11181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/19/2019] [Indexed: 11/16/2022] Open
Abstract
Prognostic value of peritumoral fibrosis (PF) in pancreatic head cancer after resection was evaluated. A total of 143 pancreatic cancer patients who underwent tumor resection were enrolled. All patients underwent routine preoperative examination, including contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI). Patients receiving preoperative chemoradiation were excluded because it affects the proportion of fibrosis and cancer cells. Histopathological confirmation and classification of pancreatic head cancer (PHC) was made according to the standards of World Health Organization and the American Joint Committee on Cancer (AJCC). The presence of fibrosis was assessed histologically, and correlated with the clinicopathological characteristics and overall survival using univariate Kaplan-Meier analysis and a stepwise multivariable Cox regression model. Vein resection, resection margin, grading, nodal status, preoperative CA19-9 levels and PF were significantly associated with overall survival. Multivariate analysis showed that all the aforementioned were independent predictive factors of survival. In addition, the survival of patients with PF was significantly worse compared to those without (HR 1.392; P=0.027). Tumor necrosis is a valuable prognostic tool that can be included in the routine post-resection histopathological evaluation of pancreatic head cancer patients.
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Affiliation(s)
- Peng Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Youmei Wang
- Department of Pharmacy, The Second Affiliated Hospital of Zhejiang University School of Medicine, Changxing Campus, Huzhou, Zhejiang 313100, P.R. China
| | - Xiaosan Fang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Xiaoming Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Guannan Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
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7
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Tsagarakis NJ, Paterakis G, Papadhimitriou SI, Kritikou-Griva E, Goumakou E, Oudatzis G, Theodorakos I, Vasileiou P. "Bone marrow aspirate automated counts on hematology analyzers: formulating a scoring system based on hematology parameters, to discriminate reactive versus myelodysplastic syndrome-related bone marrows". Int J Lab Hematol 2019; 41:542-549. [PMID: 31102331 DOI: 10.1111/ijlh.13049] [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: 02/07/2019] [Revised: 04/22/2019] [Accepted: 04/25/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Diagnosis of myelodysplastic syndromes (MDS) is usually challenging. In this context, we have attempted to employ data derived from automated analysis of bone marrow (BM) samples as an ancillary tool for the discrimination between reactive marrow and MDS. METHODS A total of 101 BM anticoagulated samples referred for flow cytometry (FCM) analysis on the clinical suspicion of MDS had been previously counted in a Mindray BC-6800 hematology analyzer (testing set). Among them, 22/101 randomly selected BM samples (comparison set) had been also simultaneously counted by an Advia 2120 and a CELL-DYN Sapphire hematology analyzer. Selected parameters obtained by Mindray BC-6800 were retrospectively evaluated with ROC and regression analysis in an attempt to formulate a discriminative scoring system (SS) for MDS. This system was further evaluated in the comparison set. RESULTS The diagnosis of MDS was established in 37/101 patients assessed ("MDS" group). Three patients were diagnosed with myelodysplastic/myeloproliferative neoplasm (MDS/MPN), while 61 revealed a "reactive" bone marrow ("RBM" group). Statistical analysis revealed significant differences in Hb, RDW-CV%, NRBC%, and RET% values between the "MDS" and the "RBM" group. Specific cutoff values were then indicated and employed for the formulation of a SS of high sensitivity (86.84%) and specificity (86.89%). The encouraging performance characteristics of the proposed SS were also confirmed in the BM comparison set. CONCLUSION Automated BM counts on hematology analyzers contributed to the formulation of a SS for the screening discrimination between reactive and MDS BM fluids, which seems to be applicable and informative, regardless of the analyzer used.
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Affiliation(s)
- Nikolaos J Tsagarakis
- Department of Laboratory Hematology, Athens Regional General Hospital "G. Gennimatas", Athens, Greece
| | - Georgios Paterakis
- Department of Immunology, Athens Regional General Hospital "G. Gennimatas", Athens, Greece
| | - Stefanos I Papadhimitriou
- Department of Laboratory Hematology, Athens Regional General Hospital "G. Gennimatas", Athens, Greece
| | - Elpiniki Kritikou-Griva
- Department of Laboratory Hematology, Athens Regional General Hospital "G. Gennimatas", Athens, Greece
| | - Eleni Goumakou
- Department of Laboratory Hematology, Athens Regional General Hospital "G. Gennimatas", Athens, Greece
| | | | - Ioannis Theodorakos
- Department of Immunology, Athens Regional General Hospital "G. Gennimatas", Athens, Greece
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8
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Hou S, Hao J, Wang YY, Zhao BB, Xiao GW, Li YQ, Liu X, Zou ZL, Yao Y, Xiong H. Retracted: EBF1 gene promotes the proliferation and inhibits the apoptosis of bone marrow CD34+ cells in patients with myelodysplastic syndrome through negative regulation of mitogen-activated protein kinase axis. J Cell Biochem 2019; 120:1407-1419. [PMID: 30335886 DOI: 10.1002/jcb.27177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/24/2018] [Indexed: 02/02/2023]
Abstract
The transcription factor, early B cell factor 1 (EBF1), plays a vital role in the lineage specification involving early B cell development and the onset of myelodysplastic syndrome (MDS). Therefore, to investigate whether or not EBF1 affects MDS as well as the transcription factor's underlying mechanism, we used CD34+ hematopoietic stem cells in bone marrow from patients with MDS. The extracted cells were then transfected with a series of EBF1, short hairpin RNA against EBF1 (shEBF1), and SB203580 (a specific mitogen-activated protein kinase [MAPK] axis inhibitor). The effects EBF1 gene and MAPK axis had on cell proliferation, apoptosis, and migration were determined by in vitro cell culturing. We made observations that involved EBF1 inhibiting the messenger RNA (mRNA) level of p38 MAPK, increasing the mRNA levels of extracellular-signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), extracellular-signal-regulated kinase 5 (ERK5), decreasing the protein expression of Bcl-2-associated X protein (Bax), and finally elevating the protein levels of B cell lymphoma/leukemia-2 (Bcl-2), stem cell factor (SCF), erythropoietin receptor (EpoR), p-ERK, p-JNK, p-ERK5, cyclin D, cyclin E, cyclin-dependent kinase 2 (CDK2), and CDK6, implying that EBF1 may very well have an inhibitory role in the MAPK axis. Another discovery found that EBF1 had a positive effect on the promotion of bone marrow CD34+ cell proliferation as well as its migration, but inhibited the apoptosis of cells. The results we obtained from this study indicated that the EBF1 gene suppresses the activation of the MAPK axis, thereby promoting both the proliferation and migration of bone marrow CD34+ cells as well as inhibiting the associating apoptosis. The effects of the EBF1 gene are likely to present a new therapeutic target in preventing the progression of MDS.
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Affiliation(s)
- Shuang Hou
- Department of Hematology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Jie Hao
- Department of Hematology, Shanghai Jingan North Station Hospital, Shanghai, China
| | - Yan-Yu Wang
- Department of Hematology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Bing-Bing Zhao
- Department of Hematology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Gong-Wei Xiao
- Department of Hematology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Yan-Qing Li
- Department of Hematology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Xi Liu
- Department of Hematology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Zhi-Lan Zou
- Department of Hematology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Ye Yao
- Department of Hematology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Hong Xiong
- Department of Hematology, Shanghai Xuhui Central Hospital, Shanghai, China
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9
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Valent P, Horny H, Arock M. The underestimated role of basophils in Ph + chronic myeloid leukaemia. Eur J Clin Invest 2018; 48:e13000. [PMID: 30019447 PMCID: PMC6175372 DOI: 10.1111/eci.13000] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 05/26/2018] [Accepted: 07/15/2018] [Indexed: 01/08/2023]
Abstract
Chronic myeloid leukaemia (CML) is a hematopoietic neoplasm defined by the chromosome translocation t(9;22) and the related oncogene, BCR-ABL1. In most patients, leukaemic cells can be kept under control using BCR-ABL1-targeting drugs. However, many patients relapse which remains a clinical challenge. In particular, patients with advanced (accelerated or blast phase) CML have a poor prognosis. So far, little is known about molecular and cellular interactions and features that contribute to disease progression and drug resistance in CML. One key prognostic factor at diagnosis is marked basophilia. However, although basophils are well-known multifunctional effector cells, their impact in CML remains uncertain. In this article, we discuss the potential role of basophils as active contributors to disease evolution and progression in CML. In particular, basophils serve as a unique source of inflammatory, angiogenic and fibrogenic molecules, such as vascular endothelial growth factor or hepatocyte growth factor. In addition, basophils provide vasoactive substances, like histamine as well as the cytokine-degrading enzyme dipeptidyl-peptidase IV which may promote stem cell mobilization and the extramedullary spread of stem and progenitor cells. Finally, basophils may produce autocrine growth factors for myeloid cells. Understanding the role of basophils in CML evolution and progression may support the development of more effective treatment concepts.
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Affiliation(s)
- Peter Valent
- Division of Hematology & HemostaseologyDepartment of Internal Medicine IMedical University of ViennaViennaAustria
- Ludwig Boltzmann Cluster OncologyMedical University of ViennaViennaAustria
| | | | - Michel Arock
- LBPA CNRS UMR8113Ecole Normale Supérieure de Paris SaclayCachanFrance
- Laboratory of HematologyPitié‐Salpêtrière HospitalParisFrance
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10
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Revising flow cytometric mini-panel for diagnosing low-grade myelodysplastic syndromes: Introducing a parameter quantifying CD33 expression on CD34+ cells. Leuk Res 2018; 71:75-81. [DOI: 10.1016/j.leukres.2018.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/05/2018] [Accepted: 07/09/2018] [Indexed: 11/18/2022]
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11
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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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12
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Atanasov G, Dietel C, Feldbrügge L, Benzing C, Krenzien F, Brandl A, Mann E, Englisch JP, Schierle K, Robson SC, Splith K, Morgul MH, Reutzel-Selke A, Jonas S, Pascher A, Bahra M, Pratschke J, Schmelzle M. Tumor necrosis and infiltrating macrophages predict survival after curative resection for cholangiocarcinoma. Oncoimmunology 2017; 6:e1331806. [PMID: 28919993 DOI: 10.1080/2162402x.2017.1331806] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/10/2017] [Accepted: 05/12/2017] [Indexed: 12/15/2022] Open
Abstract
Background. Tumor necrosis as well as tumor-associated macrophages (TAMs) in the tumor invasive front (TIF) have been suggested to have a prognostic value in selected solid tumors, inclusive hilar cholangiocarcinoma. However, little is known regarding their influence on tumor progression and prognosis in intrahepatic cholangiocarcinoma (iCC). Methods. We analyzed surgically resected tumor specimens of human iCC (n = 88) for distribution and localization of TAMs, as defined by expression of CD68, formation of necrosis and extent of peritumoral fibrosis. Abundance of TAMs, tumor necrosis and grade of fibrosis were assessed immunohistochemically and histologically and correlated with clinicopathological characteristics, tumor recurrence and patients' survival. Statistical analysis was performed using SPSS software. Results. Patients with tumors characterized by low levels of TAMs in TIF or necrosis showed a significantly decreased 1-, 3- and 5-y recurrence-free survival and a significantly decreased overall survival, when compared with patients with tumors showing high levels of TAMs in TIF or no necrosis. Patients with high density of TAMs in TIF showed significantly lower incidence of tumor recurrence, as well (p < 0.05). Absence of tumor necrosis and TAMs in TIF were confirmed as independent prognostic variables in the multivariate survival analysis (all p < 0.05). Conclusions. High levels of TAMs in TIF or absence of histologic tumor necrosis are associated with a significantly improved recurrence-free and overall survival of patients with iCC. These results suggest TAMs and necrosis as valuable prognostic markers in routine histopathologic evaluation, and might indicate more individualized therapeutic strategies.
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Affiliation(s)
- Georgi Atanasov
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Corinna Dietel
- Department of Visceral-, Transplantation-, Thoracic- and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Linda Feldbrügge
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Benzing
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Krenzien
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Brandl
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Elli Mann
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julianna Paulina Englisch
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katrin Schierle
- Institute of Pathology, University Hospital Leipzig, Leipzig, Germany
| | - Simon C Robson
- The Transplant Institute and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - Katrin Splith
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mehmet Haluk Morgul
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anja Reutzel-Selke
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sven Jonas
- Department of Hepato-Pancreato-Biliary Surgery, 310Klinik Nürnberg, Nürnberg, Germany
| | - Andreas Pascher
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Bahra
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz Schmelzle
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
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13
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Valent P, Sotlar K, Blatt K, Hartmann K, Reiter A, Sadovnik I, Sperr WR, Bettelheim P, Akin C, Bauer K, George TI, Hadzijusufovic E, Wolf D, Gotlib J, Mahon FX, Metcalfe DD, Horny HP, Arock M. Proposed diagnostic criteria and classification of basophilic leukemias and related disorders. Leukemia 2017; 31:788-797. [PMID: 28090091 DOI: 10.1038/leu.2017.15] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 12/14/2016] [Accepted: 12/19/2016] [Indexed: 01/09/2023]
Abstract
Basophils form a distinct cell lineage within the hematopoietic cell family. In various myeloid neoplasms, including chronic myeloid leukemia, basophilia is frequently seen. Acute and chronic basophilic leukemias, albeit rare, have also been described. However, no generally accepted criteria and classification of basophilic leukemias have been presented to date. To address this unmet need, a series of Working Conferences and other meetings were organized between March 2015 and March 2016. The current article provides a summary of consensus statements from these meetings, together with proposed criteria to delineate acute basophilic leukemia (ABL) from chronic basophilic leukemia (CBL) and primary forms of the disease where no preceding myeloid malignancy is detected, from the more common 'secondary' variants. Moreover, the term hyperbasophilia (HB) is proposed for cases with a persistent peripheral basophil count ⩾1000 per μl of blood. This condition, HB, is highly indicative of the presence of an underlying myeloid neoplasm. Therefore, HB is an important checkpoint in the diagnostic algorithm and requires a detailed hematologic investigation. In these patients, an underlying myeloid malignancy is often found and is then labeled with the appendix -baso, whereas primary cases of ABL or CBL are very rare. The criteria and classification proposed in this article should facilitate the diagnosis and management of patients with unexplained basophilia and basophil neoplasms in routine practice, and in clinical studies.
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Affiliation(s)
- P Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - K Sotlar
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - K Blatt
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - K Hartmann
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - A Reiter
- Department of Hematology and Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - I Sadovnik
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - W R Sperr
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - P Bettelheim
- Division of Laboratory Medicine, Elisabethinen Hospital Linz, Linz, Austria
| | - C Akin
- Division of Rheumatology, Immunology and Allergy, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - K Bauer
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - T I George
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
| | - E Hadzijusufovic
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - D Wolf
- Medical Clinic III for Oncology, Haematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - J Gotlib
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - F-X Mahon
- Laboratoire d'Hématologie, CHU de Bordeaux, France
| | - D D Metcalfe
- Laboratory of Allergic Diseases, NIAID, NIH, Bethesda, MD, USA
| | - H-P Horny
- Institute of Pathology, Ludwig-Maximilians University, Munich, Germany
| | - M Arock
- LBPA CNRS UMR8113, Ecole Normale Supérieure de Cachan, Cachan, France
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14
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Daw S, Chatterjee R, Law A, Law S. Analysis of hematopathology and alteration of JAK1/STAT3/STAT5 signaling axis in experimental myelodysplastic syndrome. Chem Biol Interact 2016; 260:176-185. [PMID: 27725143 DOI: 10.1016/j.cbi.2016.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 10/04/2016] [Accepted: 10/06/2016] [Indexed: 11/27/2022]
Abstract
Hematological disorders like myelodysplastic syndrome (MDS) may arise due to cumulative dysregulation of various signalling pathways controlling proliferation, differentiation, maturation and apoptosis of bone marrow cells. This devastating bone marrow condition can be due to consequential abnormalities in haematopoiesis as well as its supportive microenvironment. Although mutations related to JAK/STAT pathway are common in myeloproliferative neoplasms, further studies are required to fully explore the myelodysplastic scenario regarding the concerned pathway. In this study, we have investigated the JAK-STAT signalling pathway which inevitably plays a crucial role in haematopoiesis. MDS was mimicked in a mouse model with an induction of ENU in adult mice. The bone marrow of the control and MDS groups of animals were subjected to a variety of tests, including cell morphology study in peripheral blood and bone marrow, cytochemistry and histochemistry of bone marrow smears, karyotyping and flowcytometric expression analysis of the phosphorylated forms of proteins like JAK1, STAT3 and STAT5 (denoted as pJAK1, pSTAT3 and pSTAT5) and the phenotypic expression of proteins like CD45 and CD71. The results revealed that the morphology of the blood and bone marrow cells were dysplastic compared to the affected blast populations of different lineages. The expression of common leucocyte antigen CD45 was less in comparison to the expression of transferrin receptor CD71 which was increased in the ENU induced MDS mouse model. Moreover, we have observed an upregulated expression of JAK1 followed by STAT5. Therefore, we can conclude that downregulation of CD45 may have helped in the upregulation of JAK-STAT signaling and CD71 expression. This aberrant signaling may be among one of the activated signaling axes that lead to affected hematopoietic lineages in Myelodysplastic syndrome.
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Affiliation(s)
- Suchismita Daw
- Stem Cell Research and Application Unit, Department of Biochemistry and Medical Biotechnology, Calcutta School of Tropical Medicine, 108, C.R Avenue, Kolkata 700073, West Bengal, India
| | - Ritam Chatterjee
- Stem Cell Research and Application Unit, Department of Biochemistry and Medical Biotechnology, Calcutta School of Tropical Medicine, 108, C.R Avenue, Kolkata 700073, West Bengal, India
| | - Aditya Law
- Stem Cell Research and Application Unit, Department of Biochemistry and Medical Biotechnology, Calcutta School of Tropical Medicine, 108, C.R Avenue, Kolkata 700073, West Bengal, India
| | - Sujata Law
- Stem Cell Research and Application Unit, Department of Biochemistry and Medical Biotechnology, Calcutta School of Tropical Medicine, 108, C.R Avenue, Kolkata 700073, West Bengal, India.
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15
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Vasekova P, Plank L. The Differencies in Adult and Pediatric Myelodysplastic Syndrome: A Review. ACTA MEDICA MARTINIANA 2016. [DOI: 10.1515/acm-2016-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Myelodysplastic syndrome (MDS) represent very heterogenous group of clonal stem cell bone marrow disorders with ineffective haematopoesis leading to cytopenias in peripheral blood and increased risk of blastic transformation and evolution of acute myeloid leukemia. MDS is a disease of older age mostly, in children it seems to be very rare. There are several significant morphological, cytogenetic and prognostic differencies of the disease in adults and in children. Adult MDS patients most commonly manifest with symptoms of anemia, bleeding and infection are uncommon. In childhood, MDS manifests predominantly by neutropenia and thrombocytopenia. In addition, some pediatric MDS patients present also with constitutional disease’s signs and symptoms. Early and correct diagnosis in both age groups is essential for the choice of appropriate therapy and also for next life of patients. However, the diagnosis of MDS is challenging, complex and requiring close correlation of clinical symptoms, laboratory parameters and standardized examination of BM biopsies. The authors present an overview focused on biology of MDS in adults and children, on the differences in the incidence, clinical presentation and treatment. They summarize the possibilities and limits of histopathological diagnosis and differential diagnosis of the disease in different age groups. A major problem in the morphological diagnosis of MDS remains the determination, whether the myelodysplasia is due to clonal disorder. It might result also from some other factors, as significant dysplasia can also occur in reactive conditions, and vice versa, only discrete dysplasia is sometimes observed in MDS patients. Although histomorphological and immunohistochemical analysis of BM biopsy is invasive and time-consuming examination, it has its value in the diagnosis, differential diagnosis and evaluation of therapeutic effect.
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Affiliation(s)
- P Vasekova
- Comenius University in Bratislava, Jessenius Faculty of Medicine and University Hospital in Martin, Department of Pathological Anatomy, Slovakia
| | - L Plank
- Comenius University in Bratislava, Jessenius Faculty of Medicine and University Hospital in Martin, Department of Pathological Anatomy, Slovakia
- Martin s Biopsy Center, Ltd in Martin, Slovakia
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16
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Atanasov G, Schierle K, Hau HM, Dietel C, Krenzien F, Brandl A, Wiltberger G, Englisch JP, Robson SC, Reutzel-Selke A, Pascher A, Jonas S, Pratschke J, Benzing C, Schmelzle M. Prognostic Significance of Tumor Necrosis in Hilar Cholangiocarcinoma. Ann Surg Oncol 2016; 24:518-525. [PMID: 27480355 DOI: 10.1245/s10434-016-5472-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Tumor necrosis and peritumoral fibrosis have both been suggested to have a prognostic value in selected solid tumors. However, little is known regarding their influence on tumor progression and prognosis in hilar cholangiocarcinoma (HC). METHODS Surgically resected tumor specimens of HC (n = 47) were analyzed for formation of necrosis and extent of peritumoral fibrosis. Tumor necrosis and grade of fibrosis were assessed histologically and correlated with clinicopathological characteristics, tumor recurrence, and patients' survival. Univariate Kaplan-Meier analysis and a stepwise multivariable Cox regression model were applied. RESULTS Mild peritumoral fibrosis was evident in 12 tumor samples, moderate peritumoral fibrosis in 20, and high-grade fibrosis in 15. Necrosis was evident in 19 of 47 tumor samples. Patients with tumors characterized by necrosis showed a significantly decreased 5-year recurrence-free survival (37.9 vs. 25.7 %; p < .05) and a significantly decreased 5-year overall survival (42.6 vs. 12.4 %; p < .05), when compared with patients with tumors showing no necrosis. R status, tumor recurrence, and tumor necrosis were of prognostic value in the univariate analysis (all p < .05). Multivariate survival analysis confirmed tumor necrosis (p = .038) as the only independent prognostic variable. CONCLUSIONS The assessment of tumor necrosis appears as a valuable additional prognostic tool in routine histopathological evaluation of HC. These observations might have implications for monitoring and more individualized multimodal therapeutic strategies.
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Affiliation(s)
- Georgi Atanasov
- Department of Surgery, Campus Virchow and Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Katrin Schierle
- Institute of Pathology, University Hospital Leipzig, Leipzig, Germany
| | - Hans-Michael Hau
- Department of Visceral-, Transplantation-, Thoracic- and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Corinna Dietel
- Department of Visceral-, Transplantation-, Thoracic- and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Felix Krenzien
- Department of Surgery, Campus Virchow and Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Brandl
- Department of Surgery, Campus Virchow and Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Georg Wiltberger
- Department of Visceral-, Transplantation-, Thoracic- and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Julianna Paulina Englisch
- Department of Surgery, Campus Virchow and Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Simon C Robson
- The Transplant Institute and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - Anja Reutzel-Selke
- Department of Surgery, Campus Virchow and Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Pascher
- Department of Surgery, Campus Virchow and Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sven Jonas
- Department of Hepato-Pancreato-Biliary Surgery, 310Klinik Nürnberg, Nuremberg, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Virchow and Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Benzing
- Department of Surgery, Campus Virchow and Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz Schmelzle
- Department of Surgery, Campus Virchow and Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
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17
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Porwit A. Is There a Role for Flow Cytometry in the Evaluation of Patients With Myelodysplastic Syndromes? Curr Hematol Malig Rep 2015; 10:309-17. [DOI: 10.1007/s11899-015-0272-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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18
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Torlakovic EE, Brynes RK, Hyjek E, Lee SH, Kreipe H, Kremer M, McKenna R, Sadahira Y, Tzankov A, Reis M, Porwit A. ICSH guidelines for the standardization of bone marrow immunohistochemistry. Int J Lab Hematol 2015; 37:431-49. [DOI: 10.1111/ijlh.12365] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 03/02/2015] [Indexed: 12/25/2022]
Affiliation(s)
- E. E. Torlakovic
- Department of Laboratory Hematology; University Health Network; University of Toronto; Toronto ON Canada
| | - R. K. Brynes
- Department of Pathology; Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - E. Hyjek
- Department of Pathology; University of Chicago; Chicago IL USA
| | - S.-H. Lee
- Department of Haematology; St George Hospital; SEALS Central; Sydney NSW Australia
| | - H. Kreipe
- Department of Pathology; Hannover Medical School; Hannover Germany
| | - M. Kremer
- Munich Municipal Hospital; Institute of Pathology; Munich Germany
| | - R. McKenna
- Special Hematology; Department of Laboratory Medicine and Pathology; University of Minnesota; Minneapolis MN USA
| | - Y. Sadahira
- Department of Pathology; Kawasaki Medical School; Kurashiki Japan
| | - A. Tzankov
- Institute of Pathology; University Hospital Basel; Basel Switzerland
| | - M. Reis
- Department of Clinical Pathology; Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - A. Porwit
- Department of Laboratory Hematology; University Health Network; University of Toronto; Toronto ON Canada
- Department of Pathology; Karolinska Institute; Stockholm Sweden
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19
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Meers S. The myelodysplastic syndromes: the era of understanding. Eur J Haematol 2014; 94:379-90. [PMID: 25186093 DOI: 10.1111/ejh.12443] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 12/28/2022]
Abstract
Myelodysplastic syndromes are a heterogeneous group of clonal haematological stem cell disorders. Allogeneic stem cells transplantation remains the only curative treatment but only a minority of patients are eligible for this treatment. In spite of this, it has become clear that treatment with lenalidomide and azanucleotides can lead to increased overall survival in particular subsets of patients with MDS. The relative silence on the therapeutic side is counter-balanced by major advances in the understanding of this heterogeneous disease. The introduction of high-throughput molecular techniques has resulted in the discovery that most patients harbour molecular aberrations, including pathways such as the spliceosome machinery previously not known to be involved. These newly discovered pathways will undoubtedly result in new therapeutic strategies for this difficult to treat disease.
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Affiliation(s)
- Stef Meers
- AZ KLINA, Iridium Cancer Network, Brasschaat, Belgium
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20
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Fu B, Jaso JM, Sargent RL, Goswami M, Verstovsek S, Medeiros LJ, Wang SA. Bone marrow fibrosis in patients with primary myelodysplastic syndromes has prognostic value using current therapies and new risk stratification systems. Mod Pathol 2014; 27:681-9. [PMID: 24186132 DOI: 10.1038/modpathol.2013.187] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 08/09/2013] [Accepted: 08/27/2013] [Indexed: 02/03/2023]
Abstract
Bone marrow fibrosis has recently been recognized as an adverse histological feature in patients with primary myelodysplastic syndromes. In this study, we assessed the prognostic impact of bone marrow fibrosis in patients with primary myelodysplastic syndromes under the recently revised new risk stratification systems: the New Comprehensive Cytogenetic Scoring System and the Revised International Prognostic Scoring System. From 2002 to 2012, a total of 79 (13%) patients with primary myelodysplastic syndromes and moderate/severe bone marrow fibrosis were identified; and these patients were compared with a control group of 166 patients with myelodysplastic syndromes but no significant fibrosis. Bone marrow fibrosis predicted an inferior overall survival and leukemia event-free survival for patients who received no hematopoietic stem cell transplant in univariate and multivariate analysis. Eleven patients with bone marrow fibrosis and 32 control group patients underwent hematopoietic stem cell transplant; and bone marrow fibrosis was an independent risk for an inferior overall survival but not leukemia-free survival. In addition, 17 (4%) patients developed bone marrow fibrosis during the course of myelodysplastic syndromes, which was accompanied by clinical and cytogenetic evidence of disease progression. JAK2 V617F mutations were detected in 6 of the 28 patients with bone marrow fibrosis presenting at the time of diagnosis and 2 of the 7 patients with bone marrow fibrosis developing in the course of disease, significantly higher than the control group patients. We conclude that bone marrow fibrosis is an adverse risk feature in primary myelodysplastic syndromes in the current therapeutic era, and this risk feature is not captured by newly revised risk stratification systems. Inclusion of bone marrow fibrosis in patient assessment may further aid in risk-adapted therapeutic decisions.
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Affiliation(s)
- Bin Fu
- 1] Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA [2] Department of Hematology, Central South University Xiangya Hospital, Changsha, China
| | - Jesse M Jaso
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rachel L Sargent
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maitrayee Goswami
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Srdan Verstovsek
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sa A Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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21
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Machherndl-Spandl S, Sega W, Bösmüller H, Germing U, Gruber C, Nachtkamp K, Reinecke P, Sperr WR, Wimazal F, Müllauer L, Sotlar K, Horny HP, Tüchler H, Valent P, Krieger O. Prognostic impact of blast cell counts in dysplastic bone marrow disorders (MDS and CMML I) with concomitant fibrosis. Ann Hematol 2013; 93:57-64. [PMID: 24241126 DOI: 10.1007/s00277-013-1945-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 10/29/2013] [Indexed: 02/05/2023]
Abstract
In a retrospective study, 43 patients with dysplastic neoplasms of the bone marrow (myelodysplastic syndromes and myelodysplastic/myeloproliferative-overlap neoplasms) associated with marked (grades 2-3) fibrosis were examined. Histopathologic and morphologic findings as well as cytogenetic and molecular results were correlated with clinical endpoints. Multilineage dysplasia (34 of 43 patients, 79 %) and hypercellular bone marrow (64 %) were found in most patients. In ten of 35 patients, poor risk karyotypes according to the International Prognostic Scoring System (IPSS) were recorded. The JAK2 V617F mutation was detected in four of 30 patients (13 %), and the KIT D816V mutation was found in two of 30 patients (6 %). Patients were mainly treated with palliative drugs and best supportive care. After an observation time of 1-41 (median 21) months, ten of 43 patients (23 %) had developed a secondary acute leukemia. The median survival of all 43 patients was 21.4 months (range 1.8-88.2 months). Of all prognostic parameters examined, the blast cell count at diagnosis was found to be a most reliable and most predictive marker concerning survival and leukemia progression. This confirms previous studies in dysplastic bone marrow neoplasms without fibrosis.
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Affiliation(s)
- Sigrid Machherndl-Spandl
- Department of Hematology, Stem Cell Transplantation, Haemostaseology and Internal Oncology, KH Elisabethinen, Linz, Austria
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22
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Abstract
Myelodysplastic syndromes are heterogeneous bone marrow diseases with a variable pathogenetic background. Cytomorphological alterations in peripheral blood films as well as bone marrow aspirates and histological findings in trephine biopsies result from cytogenetic and molecular abnormalities, epigenetic dysregulation and immune dysfunction and are key elements for setting the diagnosis of MDS. Whereas diagnosis can be made quite easily in advanced MDS this is much more difficult in early MDS, especially in cases with cytopenias or dysplasias of uncertain significance (ICUS and IDUS). Recommendations, illustrated by case reports for a stepwise annealing to the final diagnosis and exclusion of differential diagnoses are given. Furthermore, the problem of correct counting and identification of blasts is covered and features defining dysplasia in all three cell lineages are recapitulated thoroughly. Histopathology is not mandatory but has a distinct diagnostic and prognostic value especially in cases with hypoplasia or fibrosis and when the TP53 mutational status is of relevance. In up to 70% of patients with MDS clonal chromosome abnormalities can be identified which have a high impact on setting the correct diagnosis and estimation of prognosis. Incidence, type, molecular background and clinical relevance of distinct anomalies as well as cytogenetic subgroups are presented in detail and the development of the new cytogenetic prognostic scoring system as part of the IPSS-R is explained. The value of FISH-Analysis as a complementary tool for chromosome analysis in MDS is demonstrated with special emphasis on the possibility to perform frequent cytogenetic monitoring by CD34-FISH examination of peripheral blood. Finally the evolution of MDS-classification systems from FAB to WHO with a critical discussion of their shortcomings like degree of dysplasia, blast thresholds, inclusion/exclusion of CMML, and the lack of dynamic information is presented.
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Affiliation(s)
- Aristoteles Giagounidis
- Clinic for Oncology, Hematology and Palliative Medicine, Marien Hospital Düsseldorf, Rochusstr. 2, 40479 Düsseldorf, Germany.
| | - Detlef Haase
- University of Göttingen, Department of Hematology and Oncology, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
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23
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Hanumanthu VS, Pirruccello SJ. GCSF-R expression in myelodysplastic and myeloproliferative disorders and blast dysmaturation in CML. Am J Clin Pathol 2013; 140:155-64. [PMID: 23897249 DOI: 10.1309/ajcpclhzr5kuhubm] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To characterize granulocyte colony-stimulating factor receptor (CD114) expression in normal (n = 20), myelodysplastic (n = 34), and chronic myelogenous leukemia (CML; n = 5) bone marrow by flow cytometry. METHODS Clinical bone marrow samples were analyzed using CD33/CD114/CD34/CD117/CD45. CD114 density (mean fluorescence intensity) and cellular distribution were evaluated on early blasts (CD33-), late blasts (CD33+), promyelocytes, and granulocytes. RESULTS Normal CD114 acquisition occurred on early blasts, peaked on promyelocytes, and decreased on granulocytes. Forty percent of CD34+ blasts expressed CD114 and one-third were early blasts. In myelodysplastic syndromes, altered CD114 distribution was more informative than density changes. In CML, CD114 density was significantly decreased on early blasts and expression was essentially limited to late blasts. We observed a specific blast dysmaturation pattern in CML involving CD33, CD34, and CD114 that was 83% sensitive and 100% specific in initial diagnosis. CONCLUSIONS CD114 provides useful additional detail in phenotypic assessment of hematopoietic precursor maturation.
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Affiliation(s)
- Vidya Sagar Hanumanthu
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Samuel J. Pirruccello
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
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Boveri E, Croci G, Gianelli U, Gambacorta M, Isimbaldi G, Moro A, Gianatti A, Ungari M, Morra E. Histopathological and immunohistochemical evaluation of bone marrow biopsy in myelodysplastic syndromes. Int J Hematol Oncol 2013. [DOI: 10.2217/ijh.13.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY In myelodysplastic syndromes (MDS), bone marrow biopsy (BMB) is now considered part of a multidisciplinary approach to bone marrow (BM) examination that must include cytological and cytogenetic assessment, while flow-cytometry and molecular studies can provide additional useful information. Undervalued in the past, BM histology has recently grown in importance in terms of diagnosis (i.e., MDS with BM fibrosis, hypoplastic MDS) and prognostic assessment (i.e., clusters of CD34+ blasts). Thus, BM histology must be considered complementary and not overlapping with the results of the other methods of BM study. Moreover, in recent years, numerous clinico-pathological studies have evidentiated, codified and standardized a series of histopathological parameters that are now considered essential for an effective and clinically useful histomorphological evaluation of the BMB. The aim of this work is to describe the histopathological and immunohistochemical approach to BMB that the pathologists of the Lombard Hematological Network (Rete Ematologica Lombarda [REL]; Italy) are carrying out on a standardized and shared basis in MDS patients.
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Affiliation(s)
- Emanuela Boveri
- Struttura Complessa di Anatomia Patologica, Fondazione IRCCS Policlinico San Matteo, Via Forlanini 14, Pavia, Italy
| | - Giorgio Croci
- Istituto di Anatomia Patologica, Dipartimento di Medicina Molecolare, Università di Pavia, Via Forlanini 14, Pavia, Italy
| | - Umberto Gianelli
- Unità Operativa Complessa di Anatomia Patologica, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico, Milano, Italy
| | - Marcello Gambacorta
- Struttura Complessa di Anatomia Istologia Patologica e Citogenetica, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, Milano, Italy
| | - Giuseppe Isimbaldi
- Unità Operativa di Anatomia Patologica, Citologia e Genetica Medica, Ospedale San Gerardo, Via Pergolesi 33, Monza, Italy
| | - Alessia Moro
- Unità Operativa Complessa di Anatomia Patologica, Università degli Studi di Milano, Dipartimento di Scienze della Salute, Azienda Ospedaliera San Paolo, Via Antonio di Rudinì 8, Milano, Italy
| | - Andrea Gianatti
- Unità di Struttura Complessa di Anatomia Patologica, Azienda Ospedaliera Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy
| | - Marco Ungari
- Istituto di Anatomia Patologica, Spedali Civili, Piazzale Spedali Civili 1, Brescia, Italy
| | - Enrica Morra
- Struttura di Ematologia, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, Milano, Italy
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Fang M, Zeng W, Huang L, Qin S, Zhou J, Sun H, Meng F. Association between glutathione S-transferase T1 null genotype and risk of myelodysplastic syndromes: a comprehensive meta-analysis. Tumour Biol 2013; 34:2747-52. [PMID: 23696026 DOI: 10.1007/s13277-013-0828-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/29/2013] [Indexed: 11/28/2022] Open
Abstract
Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal hematologic neoplasms, and the pathophysiology of these disorders is still unclear. Previous studies investigating the association between glutathione S-transferase Tl (GSTT1) null genotype and risk of MDS reported controversial results. We performed a comprehensive meta-analysis to clarify the effect of GSTT1 null genotype on risk of MDS. The strength of the association was measured by odds ratio (OR) with 95 % confidence interval (CI). Fifteen studies were finally included, involving a total of 1,796 cases and 2,502 controls. Subgroup analysis was performed by race. Meta-analysis of all 15 studies showed that the GSTT1 null genotype was significantly associated with an increased risk of MDS (OR = 1.47, 95 % CI 1.16-1.88, P OR = 0.002; I (2) = 54.4 %). Besides, an obvious association was also observed after adjusting the heterogeneity (OR = 1.32, 95 % CI 1.13-1.54, P OR = 0.001; I (2) = 9.0 %). Subgroup analysis by race suggested that this association existed in both Caucasians (OR = 1.40, 95 % CI 1.04-1.89, P OR = 0.027) and Asians (OR = 1.68, 95 % CI 1.00-2.81, P OR = 0.049). This meta-analysis suggests the GSTT1 null genotype is significantly associated with an increased risk of MDS in both Caucasians and Asians.
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Affiliation(s)
- Minghao Fang
- Department of Emergency Medicine, Tongji hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
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Schmitt-Graeff AH, Müller MJ, Fisch P. [Myelodysplastic syndromes. Epidemiology, molecular and morphological characteristics and risk stratification]. DER PATHOLOGE 2013; 34:45-55. [PMID: 23322304 DOI: 10.1007/s00292-012-1707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Myelodysplastic syndromes (MDS) comprise a spectrum of clonal stem cell disorders which are currently defined according to the classification scheme of the revised 2008 WHO classification but which may be further refined in the future. The clinical presentation is often characterized by unexplained isolated or multiple peripheral blood cytopenias resulting in anemia, bleeding events or increased susceptibility to infections. The generally hypercellular, but rarely hypocellular and occasionally fibrotic bone marrow shows dysplastic features in ≥ 10 % of cells of at least one of the hematopoietic lineages. These features and enhanced apoptosis, stem cell senescence and immunologic dysregulation result in ineffective hematopoiesis. Diagnostics in MDS relies on complementary consideration of hematological, morphological and cytogenetic/molecular parameters. Methods include marrow and peripheral blood cytology, cytogenetics, fluorescence in situ hybridization (FISH), trephine bone marrow biopsy examination, immunophenotyping and the evaluation of molecular markers by established and new techniques. Mutations affecting growth factor receptors, cell cycle and apoptosis regulators, intracellular signaling, transcription factors, epigenetic regulation and the splicosome are involved in MDS pathogenesis and progression.
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Affiliation(s)
- A H Schmitt-Graeff
- Institut für Pathologie, Universitätsklinikum Freiburg, Breisacherstr. 115a, 79106, Freiburg, Deutschland.
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Abstract
AbstractTraditionally, cytopenias are classified as deficiency mediated, immune mediated, BM failure induced, renal, or idiopathic, with the latter including the so-called idiopathic cytopenias of undetermined significance (ICUS). Clinical findings, symptoms, blood counts, BM findings, and other laboratory parameters are usually sufficient to reveal the type and cause of a marked cytopenia. However, in patients with chronic mild cytopenia, it may be a challenge for the physician to establish a correct diagnosis. In such patients, laboratory features and findings often reflect a diagnostic interface, so that criteria that are otherwise robust may hardly be applicable or are not helpful. Even if the BM is examined, the diagnosis often remains uncertain in these patients. In addition, more than one potential cause of cytopenia may be present, especially in the elderly. A myelodysplastic syndrome (MDS) or another BM disorder, but also an overt autoimmune or other inflammatory disease, may develop during follow-up in these patients. A key problem is that in an early phase of MDS, most laboratory and clinical signs are “nonspecific.” One of the very few reliable peripheral blood parameters distinguishing between an early or “pre-phase” of MDS and most other causes of a mild cytopenia are the numbers of circulating colony-forming progenitor cells. In addition, flow cytometric and molecular investigations may sometimes assist in the delineation between clonal and reactive conditions underlying mild cytopenias. This review provides an overview of diagnostic approaches and algorithms for patients with mild unexplained cytopenia(s).
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van de Loosdrecht AA, Ireland R, Kern W, Della Porta MG, Alhan C, Balleisen JS, Bettelheim P, Bowen DT, Burbury K, Eidenschink L, Cazzola M, Chu SSC, Cullen M, Cutler JA, Dräger AM, Feuillard J, Fenaux P, Font P, Germing U, Haase D, Hellström-Lindberg E, Johansson U, Kordasti S, Loken MR, Malcovati L, te Marvelde JG, Matarraz S, Milne T, Moshaver B, Mufti GJ, Nikolova V, Ogata K, Oelschlaegel U, Orfao A, Ossenkoppele GJ, Porwit A, Platzbecker U, Preijers F, Psarra K, Richards SJ, Subirá D, Seymour JF, Tindell V, Vallespi T, Valent P, van der Velden VHJ, Wells DA, de Witte TM, Zettl F, Béné MC, Westers TM. Rationale for the clinical application of flow cytometry in patients with myelodysplastic syndromes: position paper of an International Consortium and the European LeukemiaNet Working Group. Leuk Lymphoma 2012; 54:472-5. [PMID: 22916713 DOI: 10.3109/10428194.2012.718341] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
An international working group within the European LeukemiaNet gathered, aiming to determine the role of flow cytometry (FC) in myelodysplastic syndromes (MDS). It was agreed that FC has a substantial application in disease characterization, diagnosis and prognosis. FC may also be useful in predicting treatment responses and monitoring novel and standard therapeutic regimens. In this article the rationale is discussed that flow cytometry should be integrated as a part of diagnostic and prognostic scoring systems in MDS.
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Update on developments in the diagnosis and prognostic evaluation of patients with myelodysplastic syndromes (MDS): Consensus statements and report from an expert workshop. Leuk Res 2012; 36:264-70. [DOI: 10.1016/j.leukres.2011.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 11/07/2011] [Accepted: 11/08/2011] [Indexed: 01/13/2023]
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Westers TM, Ireland R, Kern W, Alhan C, Balleisen JS, Bettelheim P, Burbury K, Cullen M, Cutler JA, Della Porta MG, Dräger AM, Feuillard J, Font P, Germing U, Haase D, Johansson U, Kordasti S, Loken MR, Malcovati L, te Marvelde JG, Matarraz S, Milne T, Moshaver B, Mufti GJ, Ogata K, Orfao A, Porwit A, Psarra K, Richards SJ, Subirá D, Tindell V, Vallespi T, Valent P, van der Velden VHJ, de Witte TM, Wells DA, Zettl F, Béné MC, van de Loosdrecht AA. Standardization of flow cytometry in myelodysplastic syndromes: a report from an international consortium and the European LeukemiaNet Working Group. Leukemia 2012; 26:1730-41. [PMID: 22307178 DOI: 10.1038/leu.2012.30] [Citation(s) in RCA: 183] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Flow cytometry (FC) is increasingly recognized as an important tool in the diagnosis and prognosis of myelodysplastic syndromes (MDS). However, validation of current assays and agreement upon the techniques are prerequisites for its widespread acceptance and application in clinical practice. Therefore, a working group was initiated (Amsterdam, 2008) to discuss and propose standards for FC in MDS. In 2009 and 2010, representatives from 23, mainly European, institutes participated in the second and third European LeukemiaNet (ELN) MDS workshops. In the present report, minimal requirements to analyze dysplasia are refined. The proposed core markers should enable a categorization of FC results in cytopenic patients as 'normal', 'suggestive of', or 'diagnostic of' MDS. An FC report should include a description of validated FC abnormalities such as aberrant marker expression on myeloid progenitors and, furthermore, dysgranulopoiesis and/or dysmonocytopoiesis, if at least two abnormalities are evidenced. The working group is dedicated to initiate further studies to establish robust diagnostic and prognostic FC panels in MDS. An ultimate goal is to refine and improve diagnosis and prognostic scoring systems. Finally, the working group stresses that FC should be part of an integrated diagnosis rather than a separate technique.
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Affiliation(s)
- T M Westers
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
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Valent P, Bain BJ, Bennett JM, Wimazal F, Sperr WR, Mufti G, Horny HP. Idiopathic cytopenia of undetermined significance (ICUS) and idiopathic dysplasia of uncertain significance (IDUS), and their distinction from low risk MDS. Leuk Res 2011; 36:1-5. [PMID: 21920601 DOI: 10.1016/j.leukres.2011.08.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 08/01/2011] [Accepted: 08/18/2011] [Indexed: 10/17/2022]
Abstract
It is now generally appreciated that hematologic neoplasms can develop over many years if not decades, often being initially occult or showing minimal (subdiagnostic) abnormalities. However, whereas such early neoplastic conditions have been defined in some detail in lymphoproliferative neoplasms, little is known about minimal lesions preceding the manifestation of an overt myeloid neoplasm, about underlying mechanisms, the clinical course and outcome, and the prognostic significance of such conditions. Members of several groups have recently described two 'premalignant' myeloid conditions, namely idiopathic cytopenia of undetermined significance (ICUS) and idiopathic bone marrow dysplasia of uncertain significance (IDUS). At least in some patients these are neoplastic conditions. Both conditions may progress to an overt myelodysplastic syndrome (MDS), but may also progress to another myeloid neoplasm such as acute myeloid leukemia, a myeloproliferative neoplasm (MPN), or a mast cell disorder (mastocytosis). In ICUS the dysplasia is mild and does not fulfill the WHO criteria for MDS but cytopenias can be severe. In IDUS the dysplasia is prominent but cytopenias, if detectable, are mild. In both conditions it is possible that a neoplastic clone has already replaced most or all of normal bone marrow cells when ICUS or IDUS is detected, but evidence to support this possibility is not necessarily available. For both groups of patients we recommend a thorough hematologic follow up because of the potential of disease-manifestation and the unpredictable form and time of progression. In the present review, we discuss current concepts relating to ICUS and IDUS as well as diagnostic approaches and available criteria.
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Affiliation(s)
- Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria.
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van de Loosdrecht AA, Westers TM. Flow cytometry in myelodysplastic syndromes: Ready for translation into clinical practice. Leuk Res 2011; 35:850-2. [DOI: 10.1016/j.leukres.2011.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 03/21/2011] [Accepted: 03/23/2011] [Indexed: 10/18/2022]
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