Erythroid-predominant myelodysplastic syndromes: Enumeration of blasts from nonerythroid rather than total marrow cells provides superior risk stratification

Sa A. Wang, Guilin Tang, Oluwole Fadare, Suyang Hao, Azra Raza, Bruce A. Woda, Robert P. Hasserjian

Research output: Contribution to journalArticle

44 Scopus citations

Abstract

In the FAB (French-American-British) and WHO (World Heath Organization) classifications, the blasts in erythroleukemia (M6a) are enumerated from the marrow nonerythroid rather than the total-nucleated cells. However, the method for blast calculation in erythroid-predominant myelodysplastic syndrome (erythroblasts≥50%) is not specified either in the FAB or WHO classifications. We retrieved the files of 74 erythroid-predominant myelodysplastic syndrome patients (17% of all myelodysplastic syndrome) and 192 myelodysplastic syndrome controls (erythroblasts<50%). In erythroid-predominant myelodysplastic syndrome, by enumerating blasts from marrow nonerythroid cells rather than from total nucleated cells, 41 of 74 (55%) cases would be upgraded, either by disease subcategory or International Prognostic Scoring System. Importantly, the patients with <5% blasts demonstrated a superior survival to patients with ≥5% blasts (P=0.002); this distinction was lost when blasts were calculated from total-nucleated cells. Of cases with ≥5% blasts, cytogenetics rather than blast count correlated with survival. We conclude that in erythroid-predominant myelodysplastic syndrome, blast calculation as a proportion of marrow nonerythroid rather than total nucleated cells can better stratify patients into prognostically relevant groups.

Original languageEnglish (US)
Pages (from-to)1394-1402
Number of pages9
JournalModern Pathology
Volume21
Issue number11
DOIs
StatePublished - Nov 2008

Keywords

  • Blasts enumeration
  • Erythroid precursors
  • Myelodysplastic syndrome
  • Prognosis
  • Survival

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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