Evaluation of BM cytomorphology after allo-SCT in patients with AML

Abstract

Estimation of relapse risk in AML after allo-SCT is critical. The negative impact of increased blast count post transplant is widely accepted. Here, we studied cellularity and dysplasia in BM cytomorphology on days 30 and 100 in 112 AML patients who achieved haematological CR after SCT. Overall cellularity on day 30 was normal in 45.3%, reduced in 37.3% and increased in 17.3% of samples (day 100: normal: 54.8%; reduced: 38.7%; and increased: 6.5%). Dysplasia in X10% of cells was frequent on day 30 (granulopoiesis: 25.0% of samples; erythropoiesis: 34.6%; and megakaryopoiesis: 47.7%) and also on day 100. Relapses were less frequent in patients with normal BM cellularity on day 30 (7/34; 20.6%) when compared with reduced (9/28; 32.1%) or increased cellularity (10/13; 76.9%; P ¼ 0.001). Estimated 2-year OS was 59.0% for patients with normal overall cellularity, followed by patients with increased (44.0%) and reduced cellularity (31.4%, P ¼ 0.009). In contrast, cellularity at day 100 and dysplasia at days 30 and 100 did not correlate with outcome measures. Thus, in the cohort studied, BM cellularity represents a prognostic parameter for the posttransplant period in AML patients. Dysplasia seems to be an unspecific phenomenon in the cohort analysed.

Mutation Clearance after Transplantation for Myelodysplastic Syndrome

“…The prognostic usefulness of monitoring measurable residual disease after treatment for MDS and AML has been studied with the use of a variety of approaches, including morphologic analysis, assessment of chimerism, quantitative PCR, and multiparameter flow cytometry. 13,14,24–26 However, these approaches can be limited by sensitivity (e.g., in morphologic analysis and assessment of chimerism) or applicability to only a subgroup of patients (e.g., in quantitative PCR). They may also be subject to differences in interpretation among observers (e.g., in multiparameter flow cytometry).…”

Evaluation of BM cytomorphology after allo-SCT in patients with MDS

“…In stem cell recipients with AML, we described dysplasia to be a frequent but nonspecific feature after allogeneic haematopoietic SCT on day 30 and day 100. 1 Yet, we found normal cellularity by cytomorphology on day 30 to be associated with positive prognosis in these patients. 1 As dysplasia and aberrant cellularity are hallmarks of MDS, we analysed the distribution and potential prognostic impact of these features by cytomorphology in BM aspirates taken on day 100 post transplant.…”

“…1 Yet, we found normal cellularity by cytomorphology on day 30 to be associated with positive prognosis in these patients. 1 As dysplasia and aberrant cellularity are hallmarks of MDS, we analysed the distribution and potential prognostic impact of these features by cytomorphology in BM aspirates taken on day 100 post transplant. We evaluated 25 MDS and chronic myelomonocytic leukaemia (CMML) patients (11 female, 14 male, median age 58 years, range 28-73 years) in CR at day 100 after SCT.…”

“…This was in concordance with what has been described by our group for AML patients in the post-transplant period where dysplasia had been a frequent phenomenon on day 30 and day 100. 1 Interestingly, dysplasia was more frequently observed in MP than in EP or GP in this series with MDS patients. We subsequently evaluated cellularity in our MDS cohort at day 100.…”

“…This, too, was similar to the results in our AML cohort where aberrant cellularity was a frequent phenomenon on days 30 and 100. 1 After a median follow-up of 28.1 months (range 3.6-70.0 months), 5/25 (20%) patients experienced relapse with intervals ranging from 4.1 to 41.5 months after SCT. A total of 8/25 (32%) patients died within a median of 9.9 months (4.4-50.3 months).…”