Bone Marrow Biopsy in RAEB and RAEB-t Myelodysplastic Syndromes

Lambertenghi‐Deliliers, G.; Soligo, Davide; Annaloro, C.; Pozzoli, E; Riva, Alberto

doi:10.1007/978-3-642-75952-9_11

Cited by 3 publications

(8 citation statements)

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“…In a previous report (Lambertenghi et al, 1992) we pointed out that the size and not just the presence of ALIPs may be regarded as a prognostic indicator, because only patients with immature precursors aggregates of more than six cells ('large' aggregates) were invariably characterized by an unfavourable clinical outcome; on the other hand, the prognosis in patients with smaller aggregates ('clusters') was not clearly distinguishable from that of those with a 'diffuse' pattern of infiltration.…”

Section: Discussionmentioning

confidence: 95%

“…Among the morphological parameters which can be studied more accurately through BMB, the pattern of blastic infiltration proved to be the most interesting (Lambertenghi et al, 1992(Lambertenghi et al, , 1993, and the lack of correlation between this parameter and FAB subtype support their independence (Delacretaz et al, 1987). Among the morphological parameters which can be studied more accurately through BMB, the pattern of blastic infiltration proved to be the most interesting (Lambertenghi et al, 1992(Lambertenghi et al, , 1993, and the lack of correlation between this parameter and FAB subtype support their independence (Delacretaz et al, 1987).…”

Section: Discussionmentioning

confidence: 99%

“…The results emphasize the role of BMB in the diagnostic and prognostic work-up of MDS patients. Among the morphological parameters which can be studied more accurately through BMB, the pattern of blastic infiltration proved to be the most interesting (Lambertenghi et al, 1992(Lambertenghi et al, , 1993, and the lack of correlation between this parameter and FAB subtype support their independence (Delacretaz et al, 1987).…”

Section: Discussionmentioning

confidence: 99%

“…(2) Abnormalities in reticulin fibres graded as absent, slight (grade 1/2) or severe (grade 3/4) (Manoharan et al, 1979). (4) The pattern of BM blastic infiltration, according to our previous proposal (Lambertenghi et al, 1992(Lambertenghi et al, , 1993, divided into: 'diffuse': increase in immature myeloid precursors without any tendency toward forming aggregates; 'cluster': blastic aggregates not exceeding six cells; 'large': blastic aggregates with more than six cells. (4) The pattern of BM blastic infiltration, according to our previous proposal (Lambertenghi et al, 1992(Lambertenghi et al, , 1993, divided into: 'diffuse': increase in immature myeloid precursors without any tendency toward forming aggregates; 'cluster': blastic aggregates not exceeding six cells; 'large': blastic aggregates with more than six cells.…”

Section: Methodsmentioning

confidence: 99%

“…(3) Quantitative (normal, increased or decreased), maturative (blockade) and morphological (dysplasia) abnormalities in erythroid, myeloid and megakaryocytic series. (4) The pattern of BM blastic infiltration, according to our previous proposal (Lambertenghi et al, 1992(Lambertenghi et al, , 1993, divided into: 'diffuse': increase in immature myeloid precursors without any tendency toward forming aggregates; 'cluster': blastic aggregates not exceeding six cells; 'large': blastic aggregates with more than six cells.…”

Section: Methodsmentioning

confidence: 99%

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Bone marrow histology and CD34 immunostaining in the prognostic evaluation of primary myelodysplastic syndromes

et al. 1996

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The prognostic impact of bone marrow biopsy (BMB) histology and CD34 immunoreactivity was compared with that of the more conventional parameters (the FAB diagnosis, peripheral blood values, percentage of BM blasts and some common prognostic scores) in 100 MDS patients. Statistical correlations among the cytological, haematological, histological and immunohistochemical parameters and their relationship with clinical outcome were searched for. At univariate analysis, FAB classification (P < 0.001), pattern of blastic infiltration at BMB (P < 0.005), presence of CD34+ aggregates (P < 0.0005), percentage of blasts in BM aspirate (P < 0.0001) and percentage of CD34 positivity (P < 0.0001) proved to be linked to leukaemic transformation and, except for FAB classification, retained a high degree of prognostic significance in terms of survival. Leukaemic transformation occurred in 16/18 patients simultaneously presenting 'large' blastic infiltrates at BMB and CD34+ aggregates (P < 0.00001); 9/17 evaluable patients died within 12 months of diagnosis (P < 0.001)> Discriminant functions for leukaemic transformation and survival did not offer any advantage over univariate analysis in the prognostic work-up. The results indicate that the size of blastic aggregates and CD34 positivity allowed patients with a worse prognosis to be identified irrespective of their FAB subtype, but the prognostic impact is considerably greater when both parameters are simultaneously taken into account, as testified by the restricted and homogeneous subgroup of patients with both 'large' and CD34-positive aggregates.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Bone marrow histology and CD34 immunostaining in the prognostic evaluation of primary myelodysplastic syndromes

et al. 1996

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Prognostic relevance of histological findings on bone marrow biopsy in myelodysplastic syndromes

Lambertenghi‐Deliliers

Annaloro

Oriani

et al. 1993

Ann Hematol

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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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Risk assessment in myelodysplastic syndromes: Value of clinical, hematologic and bone marrow histologic findings at presentation

Morra

Lazzarino

Castello

et al. 1990

European J of Haematology

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We analyzed the prognostic value of clinical, hematologic and bone marrow (BM) histologic findings at presentation in 94 patients with myelodysplastic syndromes (MDS) (28 RA; 2 RARS; 34 RAEB; 6 CMML; 24 RAEB‐t). With survival as the dependent variable, stepwise multivariate analysis indicated as the prognostically most important factors among the MDS taken as a whole: latency from the first symptoms to diagnosis, age, and percentage of BM blasts. In each main MDS group the most unfavorable initial characteristics were: l)low Hb, no macro‐megaloblastosis, male sex for RA/RARS; 2) low Hb and low platelet levels for RAEB/CMML; 3) granuloblastic hyperplasia and high BM blastosis for RAEB‐t. Of the BM histologic parameters, only the percentage of blasts had significant prognostic value. Histologic assessment of BM blastosis, however, did not differ statistically from that based on cytologic examination of BM smears, so that marrow histology seemed not essential for initial prognostic assessment in MDS patients. The finding of abnormal localization of immature precursors (ALIP) in BM biopsies was associated with a negative trend without reaching statistical significance. Using four objective parameters of proven significance (age, Hb, platelets, and BM blasts) we devised a staging system of immediate clinical utility for prognostic stratification and risk‐adapted therapeutic choices.

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Bone Marrow Biopsy in RAEB and RAEB-t Myelodysplastic Syndromes

Cited by 3 publications

References 6 publications

Bone marrow histology and CD34 immunostaining in the prognostic evaluation of primary myelodysplastic syndromes

Bone marrow histology and CD34 immunostaining in the prognostic evaluation of primary myelodysplastic syndromes

Prognostic relevance of histological findings on bone marrow biopsy in myelodysplastic syndromes

Risk assessment in myelodysplastic syndromes: Value of clinical, hematologic and bone marrow histologic findings at presentation

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