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

Abstract

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.

Clinical significance of phenotypic features of blasts in patients with myelodysplastic syndrome

“…Prior reports showed that an increase in CD34 ϩ cells in the PB and the BM was associated with poor survival and a higher risk of leukemic transformation in MDS. [29][30][31] In view of the present data that CD34 is expressed by a high percentage of EBCs in nearly all MDS cases, we consider that the prior data simply denote that an increase in blasts in the PB and the BM was associated with a poor prognosis in MDS. Contrary to the common CD34 ϩ CD38 ϩ HLA-DR ϩ CD13 ϩ CD33 ϩ phenotype, MDS EBCs from various proportions of cases expressed other antigens that are expressed on normal myeloid cells more mature than myeloblasts.…”

Apparent expansion of CD34+ cells during the evolution of myelodysplastic syndromes to acute myeloid leukemia

“…We believe that this phenomenon is the result of clonal expansion of genetically altered blast cells with less or no apoptosis and with slower proliferation rates than their more mature counterparts in a different microenvironment of cytokines and probably changed stromal interactions. The immunohistochemical double-labeling technique we described can be used to follow MDS evolution and probably determine prognosis and leukemic transformation with greater accuracy than before and irrespective of their FAB subtype, like Oriani et al 48 have shown for single-labeling CD34 immunostaining. The different biological processes which lead to changes in size and proliferative capacity of the CD34 + and CD34 − compartments within MDS in evolution have been discussed and are pathophysiologically expressed in Figure 7.…”

“…12, 29,32,47,48 Within AML after MDS the prognostic relevance of CD34 expression has not been demonstrated yet, because no studies on this selected subgroup within AML have been performed. In this study we found a higher CD34 expression in AML after previous MDS as compared with the MDS subgroups, which is the first evidence in literature of a prognostic meaning of CD34 expression in AML-MDS.…”

Bone Marrow Examination for Unexplained Cytopenias Reveals Nonspecific Findings in Patients With Collagen Vascular Disease

“…Also of note, some of the drugs used to treat CVD may be implicated in megaloblastosis. [15][16][17][18][19] Likewise, ALIPs, while not specific, can also be seen in myelodysplastic syndrome, [20][21][22][23][24][25] during myeloid regeneration after myeloablative chemotherapy, and with granulocyte colony-stimulating factor therapy. 26 Lymphoid aggregates are a very nonspecific finding but have been associated with certain drug/therapy effects, other immune and inflammatory conditions, and viral infections.…”