Cellularity, characteristics of hematopoietic parameters and prognosis in myelodysplastic syndromes

Abstract

Background: Myelodysplastic syndromes (MDS) present with a normo-or hyperplastic bone marrow in most cases. We aimed at a characterization of patients with different types of cellularity. Methods: We assessed marrow cellularity both by histology and cytology in 1270 patients and analyzed hematologic, cytogenetic, and prognostic parameters accordingly. Results: The concordance of the assessment of cellularity differed dramatically between histology and cytology as only 36.5% were described as hypocellular by both methods (P < 0.0005) (hypocellular 16.4%, normocellular 23.3%, hypercellular 60.3%). There were no major differences with regard to hematopoietic insufficiency. The presence of fibrosis was associated to hypercellular bone marrow. Median survival differed from 38 months in hypocellular, 42 months in normocellular, and 25 months in hypercellular MDS (P < 0.0005). AML progression rates were 33% for hypercellular MDS after 2 yr, whereas hypo-and normocellular had a progression rate of 19% after 2 yr (P = 0.018). IPSS and IPSS-R were able to identify different risk groups within all three cellularity groups. Conclusion: Based on our data, hypocellular patients obviously do not present as a separate entity, as there were no striking differences with regard to cytogenetics and WHO types. Assessment of cellularity should be performed by histopathology.

DNA repair gene expressions are related to bone marrow cellularity in myelodysplastic syndrome

“…We determined the cutoff value using the Cutoff Finder biostatistical tool to discriminate survival by Kaplan–Meier with log-rank post-test9 (table 4). This method correlates the dichotomised biomarker with a binary outcome using logistic regression 9…”

“…We identified two subgroups of patients according to gene expression: lower group (when expression was lower than or equal to the cutoff value) and higher group (when expression was higher than the cutoff value) 9. We detected that the decreased expression of BRCA2 (p=0.004, OR=12.500, 95% CI 2.190 to 71.363) and ERCC8 (p=0.030, OR=11.900, 95% CI 1.272 to 111.3512) genes were associated with diagnosis of hMDS (table 4).…”

“…The best DNA repair expression cutoff point predicting MDS overall survival was calculated using the web-based Cutoff Finder software9 (Cutoff Finder—http://molpath.charite.de/cutoff/index.jsp) by Kaplan–Meier curve analysis based on the log-rank test.…”

“…Schemenau et al 9 evaluated the prognostic importance of cellularity among 1270 patients with MDS and showed that for cases with hypercellular, normocellular and hypocellular bone marrow there was a significant difference in median survival of 25 months, 42 months and 38 months, respectively 9. Acute myeloid leukaemia progression rates were 33% after 2 years (hypercellular), whereas normocellular and hypocellular cases showed a progression of only 19%.…”

Diagnostics of myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML)

“…It may also be useful diagnostically to do a histomorphological assessment of the bone marrow, which allows for a far better estimation of cellularity [7], which in turn may be especially relevant in differentiating from an aplastic syndrome, but may also detect bone marrow fibrosis [8], which can have a negative impact on the course of the disease. Ringed sideroblasts can be represented only in the smear, but not in a section slide.…”