Revisiting guidelines for integration of flow cytometry results in the WHO classification of myelodysplastic syndromes—proposal from the International/European LeukemiaNet Working Group for Flow Cytometry in MDS

Porwit, Anna; Loosdrecht, Arjan A. van de; Bettelheim, Peter; Brodersen, Lisa Eidenschink; Burbury, Kate; Cremers, Eline M.P.; Porta, Matteo Giovanni Della; Ireland, Robin; Johansson, Ulrika; Matarraz, Sergio; Ogata, Kíyoyuki; Órfão, Alberto; Preijers, Frank; Psarra, Katherina; Subirá, Dolores; Valent, Peter; Velden, Vincent H.J. van der; Wells, Denise A.; Westers, Theresia M.; Kern, Wolfgang; Béné, Marie‐Christine

doi:10.1038/leu.2014.191

Cited by 123 publications

(165 citation statements)

References 58 publications

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“…9,11,[17][18][19][20][21] With a view to standardizing MFC in MDS, the European LeukemiaNet (ELN) working group on MDS has defined minimal prerequisites for MFC diagnosis of MDS. 21,22 These include markers of myeloid progenitors allowing detection of an abnormal expression of CD45, CD34, CD117, HLA-DR, CD13 or CD33, asynchronous expression of CD11b or CD15 and ectopic expression of CD5, CD7, CD56 or CD19.21,22 Some intracellular markers have also been assessed in MDS, such as myeloperoxidase activity 23 or, more recently, ferritin content 24 or expression of the myeloid nuclear differentiation antigen (MNDA). 25 Other intracellular markers, such as TREM-1, that have been proven to be important in myelomonocytic differentiation and are altered in other pathological situations, could also be suggested (see review by Arts et al 26 ).…”

Section: Discussionmentioning

confidence: 99%

Multicentric study underlining the interest of adding CD5, CD7 and CD56 expression assessment to the flow cytometric Ogata score in myelodysplastic syndromes and myelodysplastic/myeloproliferative neoplasms

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Multicentric study underlining the interest of adding CD5, CD7 and CD56 expression assessment to the flow cytometric Ogata score in myelodysplastic syndromes and myelodysplastic/myeloproliferative neoplasms

et al. 2015

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“…These publications have stressed the importance of using published guidelines to develop flow cytometry testing of MDS in individual laboratories and that specific recommended published panels be used. [19][20][21] Although it is recognized that flow cytometry immunophenotyping may be a useful ancillary technique in the evaluation of MDS, its use will not be required or even specifically recommended in the diagnostic work-up of MDS in the upcoming WHO revision. However, it will be noted that flow cytometry immunophenotyping in suspected MDS cases does provide useful information and, if performed, should be resulted as part of an integrated report that includes morphology and other findings.…”

Section: Cytogenetics Mutation Analysis and Flow Cytometry Immunophementioning

confidence: 99%

Reclassifying myelodysplastic syndromes: what's where in the new WHO and why

Arber

Hasserjian

2015

Hematology

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A revision to the 4th edition of the WHO Classification of myelodysplastic syndromes (MDSs), originally published in 2008, is expected in mid-2016. Based on recommendations of a Clinical Advisory Committee, the revision will aim to incorporate new discoveries in MDS that impact existing disease categories. Although the basic diagnostic principles of the WHO classification remain unchanged, several changes to the classification are proposed. All revisions are considered preliminary until the actual publication of the monograph and online document. Proposals for change include abandoning the routine use of "refractory anemia/cytopenia" in the various disease names, including the prognostic significance of gene mutations in MDS, revising the diagnostic criteria for MDS entities with ring sideroblasts based on the detection of SF3B1 mutations, modifying the cytogenetic criteria for MDS with isolated del(5q), reclassifying most cases of the erythroid/myeloid type of acute erythroleukemia, and recognizing the familial link in some cases of MDS. This review will provide details of the major proposed changes as well as rationale for the revisions. Learning Objective• Understand proposed changes to the WHO classification of myelodysplastic syndromes

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“…Therefore, in the future, data from multiple somatic mutations (details discussed with Genetics), combinations of mutations with high allele burden and abnormal flow cytometry patterns may serve as diagnostic adjuncts in the absence of clear-cut morphological findings [43].…”

Section: Introductionmentioning

confidence: 99%

Myelodysplastic syndromes: Contemporary review and how we treat

2015

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Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal stem cell disorders with an inherent tendency for leukemic transformation. Diagnosis is currently based on the presence of peripheral blood cytopenias, peripheral blood and bone marrow dysplasia/blasts, and clonal cytogenetic abnormalities. With the advent of next generation sequencing, recurrent somatic mutations in genes involved in epigenetic regulation (TET2, ASXL1, EZH2, DNMT3A, IDH1/2), RNA splicing (SF3B1, SRSF2, U2AF1, ZRSR2), DNA damage response (TP53), transcriptional regulation (RUNX1, BCOR, ETV6) and signal transduction (CBL, NRAS, JAK2) have been identified in MDS. Conventional prognostication is by the revised International prognostic scoring system (IPSS-R) with additional adverse prognosis conferred by presence of ASXL1, EZH2, or TP53 mutations. Currently Food and Drug administration (FDA)-approved drugs for the treatment of MDS are not curative and their effect on survival is limited; they include the hypomethylating agents (HMA) azacitidine and decitabine and lenalidomide for MDS with isolated del(5q). To date, allogeneic stem cell transplant (ASCT) remains the only treatment option for possible cure. Given the current lack of drugs with convincing evidence of favorable effect on survival, we consider ASCT as the treatment of choice for most patients with symptomatic disease, and especially for those with high-risk disease. For nontransplant candidates, participation in clinical trials is preferred over conventional therapy. There is not one right way of treatment for patients who are not candidates for either ASCT or clinical trials and palliative drugs of choice depend on the clinical problem, such as symptomatic anemia (ESAs, danazol, HMA), thrombocytopenia (HMA), or neutropenia (myeloid growth factors). Conversely, there is no controlled evidence to support the use of iron chelating agents in MDS. Going forward, we believe it is time to incorporate mutation information in clinically derived prognostic models in MDS and encourage development of novel drugs with disease-modifying activity.

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Revisiting guidelines for integration of flow cytometry results in the WHO classification of myelodysplastic syndromes—proposal from the International/European LeukemiaNet Working Group for Flow Cytometry in MDS

Cited by 123 publications

References 58 publications

Multicentric study underlining the interest of adding CD5, CD7 and CD56 expression assessment to the flow cytometric Ogata score in myelodysplastic syndromes and myelodysplastic/myeloproliferative neoplasms

Multicentric study underlining the interest of adding CD5, CD7 and CD56 expression assessment to the flow cytometric Ogata score in myelodysplastic syndromes and myelodysplastic/myeloproliferative neoplasms

Reclassifying myelodysplastic syndromes: what's where in the new WHO and why

Myelodysplastic syndromes: Contemporary review and how we treat

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