Summary
Bone marrow biopsy (BMB) has aroused growing interest as a possible aid in the diagnostic and prognostic evaluation of myelodysplastic syndromes (MDS). Previous reports have pointed out that MDS patients with blastic aggregates or severe bone marrow (BM) fibrosis are characterized by a worse clinical outcome. BMBs of 106 MDS patients were retrospectively reviewed, and relationships among the different histological parameters as well as clinicopathological correlations were looked for. Three patterns of BM blastic infiltration (“diffuse,” “cluster,” and “large”) were recognized. Overt leukemic transformation and overall survival were selected as prognostic end points. BM infiltration was “diffuse” in 18, “cluster” in 48, and “large” in 40 cases. RAEB-t patients accounted for about half of the “large” cases, and none had a “diffuse” pattern (p<0.01). Nineteen patients showed extensive BM fibrosis; most of them were characterized by “cluster” blastic infiltration and megakaryocyte hyperplasia. Leukemic transformation occurred in 67% of “large” cases (p<0.001) and in none of the “cluster” cases with severe BM fibrosis (p<0.01); however, survival was equally poor in these two groups because of early leukemic transformation (large cases) and BM failure (cluster cases). The FAB classification did not significantly correlate with prognosis. Patients with “cluster” BM infiltration and severe fibrosis can be regarded as a true separate MDS subset characterized by unique clinicopathological and prognostic features. Because of the subacute clinical behavior of most cases, and the poor performance status of many elderly patients, there is still controversy as to the best therapeutic approach in MDS. Histological analysis allowed two groups of MDS patients to be identified, both characterized by poor life expectancy, who could benefit from early aggressive chemotherapy.
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References
Benitez J, Carbonell F, Sanchez Fayos J, Heimpel H (1985) Karyotypic evolution in patients with MDS. Cancer Genet Cytogenet 16: 156–167
Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DAG, Gralnick HR, Sultan C (1976) Proposals for the classification of the acute leukemias. Br J Haematol 33: 451–454
Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DAG, Gralnick HR, Sultan C (1982) Proposals for the classification of myelodysplastic syndromes. Br J Haematol 51: 189–199
Beris P (1989) Primary clonal myelodysplastic syndromes. Semin Hematol 26: 216–233
Cassano E, Giordano M, Riccardi A, Cocci A, Cazzola M (1990) Myelodysplastic syndromes: a multiparametric study of prognostic factors and a proposed scoring system. Haematologica (Pavia) 75: 141–145
Coiffier B, Adeleine P, Viala JJ, Bryon PA, Fiere D, Gentilhomme O, Vuvan H (1983) Dysmyelopoietic syndromes: a search for prognostic factors. Cancer 52: 83–90
Coiffier B, Adeleine P, Gentilhomme O, Felman P, Treille-Ritouet D, Bryon PA (1987) Myelodysplastic syndromes. A multiparametric study of prognostic factors in 336 patients. Cancer 60: 3029–3032
Fenaux P, Morel P, Rose C, Lai JL, Jouet JP, Bauters F (1991) Prognostic factors in adult de novo myelodysplastic syndromes treated by intensive chemotherapy. Br J Haematol 77: 497–501
Garcia S, Sanz MA, Amigo V, Colomina P, Carrera MD, Lorenzo JI, Sanz GF (1988) Prognostic factors in chronic myelodysplastic syndromes: a multivariate analysis in 107 cases. Am J Hematol 27: 163–168
Hamblin TJ, Oscier DG (1987) The myelodysplastic syndrome: a practical guide. Hematol Oncol 5: 19–34
Horiike S, Taniwaki M, Misawa S, Abe T (1988) Chromosome abnormality as end karyotypic evolution in 83 patients with MDS and predictive value for prognosis. Cancer 62: 1129–1138
Jacobs RH, Cornbleet MA, Vardiman JW, Larson RA, Le Beau M, Rowley JD (1986) Prognostic implications of morphology and karyotype in primary myelodysplastic syndromes. Blood 67: 1765–1772
Kitagawa M, Kamiyama R, Takemura T, Kasuga T (1989) Bone marrow analysis of the myelodysplastic syndromes: histological and immunohistochemical features related to the evolution of overt leukemia. Virchows Archiv B 57: 47–53
Lambertenghi-Deliliers G, Orazi A, Luksch R, Annaloro C, Soligo D (1991) Myelodysplastic syndrome with increased marrow fibrosis: a distinct clinico-pathological entity. Br J Haematol 78: 161–166
Lambertenghi-Deliliers G, Soligo D, Annaloro C, Pozzoli E, Riva A (1992) Bone marrow biopsy in RAEB and RAEB-t myelodysplastic syndromes. In: Schmalzl F, Mufti GJ (eds) Myelodysplastic syndromes. Springer, Berlin Heidelberg New York, pp 67–73
Mangi MH, Salisbury JR, Mufti GJ (1991) Abnormal localization of immature precursors (ALIP) in the bone marrow of myelodysplastic syndromes: current state of knowledge and future directions. Leukemia Res 7: 627–639
Manoharan A, Horsley R, Pitney WR (1979) The reticulin content of bone marrow in acute leukaemia in adults. Br J Haematol 43: 185–190
Mertelsmann R, Tvzi Thaler H, To L, Gee TS, McKenzie S, Schauer P, Friedman A, Arlin Z, Cirrincione C, Clarkson B (1980) Morphological classification, response to therapy, and survival in 263 adult patients with acute nonlymphoblastic leukemia. Blood 56: 773–781
Ohyashiki K, Sasao I, Ohyashiki JH, Murakami T, Iwabuchi A, Tauchi T, Saito M, Nakazawa S, Serizaw H, Ebihara Y, Toyama K (1990) Clinical and cytogenetic caracteristics of myelodysplastic syndromes developing myelofibrosis. Cancer 68: 178–183
Pagliuca A, Layton DM, Manoharan A, Gordon S, Green PJ, Mufti GJ (1989) Myelofibrosis in primary myelodysplastic syndromes: a clinicomorphological study of 10 cases. Br J Haematol 71: 499–504
Ríos A, Canizo MC, Sanz MA, Vallespi P, Sanz G, Torrabadella M, Gomis F, Ruiz C, San Miguel JF (1990) Bone marrow biopsy in myelodysplastic syndromes: morphological characteristics and contribution to the study of prognostic factors. Br J Haematol 75: 26–33
Sanz GF, Sanz MA, Vallespi T, Canizo MC, Torrabadella M, Garcia S, Irriguible D, San Miguel JF (1989) Two regression models and a scoring system for predicting survival and planning treatment in myelodysplastic syndromes: a multivariate analysis of prognostic factors in 370 patients. Blood 74: 395–408
Sultan C, Sigaux F, Imbert M, Reyes F (1981) Acute myelodysplasia with myelofibrosis: a report of eight cases. Br J Haematol 49: 11–16
Thiele J, Quitman H, Wagner S, Fischer R (1991) Dysmegakaryopoiesis in myelodysplastic syndromes (MDS): an immunomorphometric study of bone marrow trephine biopsy specimens. J Clin Pathol 44: 300–305
Tricot G, De Wolf-Peeters C, Vlientinck R, Verwilghen RL (1984) Bone marrow histology in myelodysplastic syndromes. II. Prognostic value of abnormal localization of immature precursors in MDS. Br J Haematol 58: 217–225
Tricot G, Vlietinck R, Boogaerts MA (1985) Prognostic factors in the MDS. Importance of initial data on peripheral blood counts, bone marrow cytology, trephine biopsy and chromosomal analysis. Br J Haematol 60: 19–32
Verhoef GEG, De Wolf-Peeters C, Ferrant A, Deprez S, Meeus P, Stul M, Zacheé P, Cassiman JJ, Van den Berghe H, Boogaerts MA (1991) Myelodysplastic syndromes with bone marrow fibrosis: a myelodysplastic disorder with proliferative features. Ann Hematol 63: 235–241
Verhoef GEG, De Wolf-Peeters C, Van de Broeck J, Zacchée P, Boogaerts MA (1991) Update on the prognostic value of bone marrow histology in patients with primary myelodysplastic syndromes. Blood 78 [Suppl 1]: 332a
Watts EJ, Majer RV, Green PJ, Mavor WO (1991) Hyperfibrotic myelodysplasia: a report of three cases showing haematological remission following treatment with prednisolone. Br J Haematol 78: 120–122
Weisdorf DJ, Oken MM, Johnson GJ, Rydell RE (1983) Chronic myelodysplastic syndrome: short survival with or without evolution to acute leukemia. Br J Haematol 55: 691–700
Yunis JJ, Rydell RE, Oken MM, Arnesen MA, Mayer MG, Lobell MM (1986) Refined chromosome analysis as an independent prognostic indicator in de novo MDS. Blood 67: 1721–1730
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Lambertenghi-Deliliers, G., Annaloro, C., Oriani, A. et al. Prognostic relevance of histological findings on bone marrow biopsy in myelodysplastic syndromes. Ann Hematol 66, 85–91 (1993). https://doi.org/10.1007/BF01695890
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DOI: https://doi.org/10.1007/BF01695890