Blast vacuolization in AML patients indicates adverse-risk AML and is associated with impaired survival after intensive induction chemotherapy

Abstract

IntroductionVacuolization is a frequently found morphological feature in acute myeloid leukemia (AML) blasts. Subcellular origin and biological function as well as prognostic impact are currently unknown. The aim of this study was to evaluate whether vacuolization correlates with clinically relevant AML features.Materials & methodsBone marrow smears of patients diagnosed with AML at the University Hospital Frankfurt between January 2011 and August 2013 were analyzed for blast vacuolization and correlated with clinically relevant AML features. Patients undergoing standard induction chemotherapy were further analyzed for molecular and cytogenetic features as well as treatment response and survival.Results14 of 100 patients diagnosed with AML receiving standard induction chemotherapy had evidence of blast vacuolization. Positivity for vacuolization correlated with a CD15 positive immunophenotype and with a higher incidence of high-risk AML according to the European LeukemiaNet risk stratification. AML patients with blast vacuolization had a poor blast clearance after standard induction chemotherapy and poor survival.DiscussionIn conclusion, our findings demonstrate that vacuolization can easily be determined in myeloid leukemia blasts and may be a useful biomarker to predict AML risk groups as well as early treatment response rates and survival.

Vacuolization of hematopoietic precursors: an enigma with multiple etiologies

“… 6 Moreover, blast vacuoles predicted poor overall survival in AML patients undergoing induction chemotherapy. 5 Finally, it is noteworthy that various BM dysplastic changes have been previously found in patients receiving chemotherapy for hematologic malignancies; in the case of vacuolization of HPs, a putative treatment-related effect may be invoked, especially in cases where this feature appears in specimens collected during follow-up. 13 , 14 …”

VEXAS syndrome: A review of bone marrow aspirate and biopsies reporting myeloid and erythroid precursor vacuolation

“…Vacuolation of ME precursors are a dysplastic feature associated with multiple processes such as copper deficiency, acute alcohol toxicity, MDS, and AML 3–6 . Historically, certain pathognomonic morphologic features have been critical in diagnosing underlying disease pathology.…”

“…2 Vacuolation of ME precursors are a dysplastic feature associated with multiple processes such as copper deficiency, acute alcohol toxicity, MDS, and AML. [3][4][5][6] Historically, certain pathognomonic morphologic features have been critical in diagnosing underlying disease pathology. In the era of high quality, molecular diagnostics the role of morphology is often complementary to other diagnostic modalities.…”

Evaluation Study of Different Techniques in Diagnosis of Acute Leukemia in Adults and Children Patients

“…Acute leukemia is a complex disease, there are two main types of leukemia, myelogenous (AML) and lymphocytic (ALL), depended on the types of cell that are involved. On the other hand each type is subdivided into acute and chronic classes (1) . That can affect each of adults and children at different ages (2).…”