Having a higher blast percentage in circulation than bone marrow: clinical implications in myelodysplastic syndrome and acute lymphoid and myeloid leukemias

Abstract

Determining the percentage of peripheral blood (PB) and bone marrow (BM) blasts is important for diagnosing and classifying acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). Although most patients with acute leukemia or MDS have a higher percentage of BM blasts than PB blasts, the relative proportion is reversed in some patients. We explored the clinical relevance of this phenomenon in MDS (n ¼ 446), AML (n ¼ 1314), and acute lymphoblastic leukemia (ALL) (n ¼ 385). Among patients with MDS or ALL, but not AML, having a higher blast percentage in PB than in BM was associated with significantly shorter survival. In multivariate analyses, these associations were independent of other relevant predictors, including cytogenetic status. Our findings suggest that MDS and ALL patients who have a higher percentage of PB blasts than BM blasts have more aggressive disease. These data also suggest that MDS classification schemes should take into account the percentage of blasts in PB differently from the percentage of blasts in BM.

Overexpression of Bcl2 protein predicts chemoresistance in acute myeloid leukemia: Its correlation with FLT3

“…Similarly, Bcl2 has been reported as independent predictive factor of survival by Campos et al [23], independent prognostic factor for achieving complete remission by Lauria et al [16] and independent prognostic factor for reduced OS and EFS by Kornblau et al [20]. Our findings are consistent with studies by Chang et al [30] and Meshinchi et al [31] demonstrating WBC count as significant prognostic factor while blast count was demonstrated to be of prognostic significance for reduced OS by Amin et al [32]. Also, in multivariate analysis, the subgroup of Bcl2+/FLT3 protein+ emerged as significant prognostic factor followed by high WBC count for predicting poor DFS.…”

Comprehensive FLT3 analysis in Indian acute myeloid leukaemia

“…These findings are consistent with studies which demonstrated WBC count as significant prognostic factor in AML [60][61] while blast count was demonstrated to be of prognostic significance for reduced OS in AML patients as shown by Amin et al [62].…”

Acute erythroid leukemia: a reassessment using criteria refined in the 2008 WHO classification

“…However, in contrast to MDS [21][22][23] survival of AEL patients in our series was not related to bone marrow or peripheral blood blast counts or to the number of dysplastic lineages. The number of cytopenias in AEL patients did significantly correlate with survival, as patients with a single cytopenia had a better survival (P ϭ .049) than patients with 2 or 3 cytopenias.…”