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Considering bone marrow blasts from nonerythroid cells improves prognostication of MDS
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Calculating percentages of bone marrow blasts from nonerythroid cells improved the prognostic assessment of patients with myelodysplastic syndrome, regardless of the presence of erythroid hyperplasia, according to study results published in Journal of Clinical Oncology.
The WHO uses bone marrow blast percentages, considered from total nucleated cells, to classify myeloid malignancies.
“In myelodysplastic syndrome with 50% or fewer bone marrow erythroblasts, there is no consensus on the best method for enumerating bone marrow blasts — from total nucleated cells or from nonerythroid nucleated cells,” Leonor Arenillas, MD, of Hospital del Mar Research Institute in Barcelona, and colleagues wrote. “Despite the lack of agreement, WHO recommendation is to consider blasts from total nucleated cells once the diagnosis of erythroleukemia is ruled out, which implies the presence of 20% or fewer bone marrow blasts from nonerythroid cells.”
Arenillas and colleagues sought to determine the best method for calculating percentages of bone marrow blasts for prognostic utility in patients with myelodysplastic syndrome, because bone marrow blasts can serve as a major prognostic factor for outcomes.
The researchers used the Grupo Español de Síndromes Mielodisplásicos database to identify 3,692 patients with myelodysplastic syndrome. The database included 465 patients with erythroid hyperplasia; the remaining 3,227 patients did not have erythroid hyperplasia.
Arenillas and colleagues assessed the percentage of bone marrow blasts — from total nucleated cells and nonerythroid cells — as they pertained to classification and prognostic value for these patients.
Enumerating blasts systemically from nonerythroid cells caused 22% (n = 89) of patients with erythroid hyperplasia and 12% (n = 330) of patients without erythroid hyperplasia who had originally been diagnosed within WHO categories of less than 5% bone marrow blasts to be reclassified into higher-risk categories (P = .006).
These patients also showed poorer OS than patients who remained in their initial categories (P = .001).
According to WHO classification, patients with erythroid hyperplasia cannot be diagnosed with refractory anemia with excess blasts–2 (RAEB-2), because 10% to less than 20% bone marrow blasts from total nucleated cells is considered erythroleukemia. However, the researchers identified 72 patients who could be classified as having RAEB-2 through the use of nonerythroid cells.
These patients had inferior median OS compared with patients with RAEB-1 without erythroid hyperplasia (28.9 months vs. 34.9 months; P = .037) but longer median OS compared with patients with RAEB-2 and fewer than 50% bone marrow erythroblasts (28.9 months vs. 13.4; P = .025).
Overall, enumerating blasts from nonerythroid cells and recalculating the International Prognosis Scoring System cause 8.4% (n = 258) of patients to be reclassified from lower-risk categories to higher-risk categories.
These patients had significantly reduced OS outcomes compared with patients who remained in lower-risk categories (median, 34.1 months vs. 76.1 months; P < .001).
“Our findings mean an important change in the global paradigm of prognostication in myelodysplastic syndrome and should be considered in future WHO myelodysplastic syndrome classifications,” Arenillas and colleagues wrote. – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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