The Prognostic Implications of Nucleated Red Blood Cells in Myelodysplastic Syndrome

Abstract

5058 Background: The presence of elevated nucleated red blood cells (NRBC) in the peripheral blood smear points towards the presence of myelodysplastic syndrome (MDS) or myelophthisis. The intent of our study was to assess the prognostic implication of the presence of increased NRBC in patients with MDS. Methods: Retrospective single institution chart review over a period of 10 years from 2000 to 2010. Our study population comprised 288 diagnosed cases of MDS whose diagnoses were made by bone marrow (BM) examination. Results: 174 patients were male (60.4%) and 114 were female (39.6%). Average age at diagnosis of MDS was 71.92 years. 204 patients were Caucasian (70.8%), 69 patients were African-American (23.9%), 1 patient was Hispanic, 2 patients were Asian, and race was not documented in 12 patients. 117 patients had intermediate-1 IPSS (40.6%), 79 had low IPSS (27.4%), 54 patients had intermediate-2 IPSS (18.7%), 26 patients had high IPSS (9.0%), and 12 patients had unknown IPSS. 131 patients (45.5%) had undetectable NRBC in their peripheral smear prior to their initial diagnostic BM examination. 13 out of these 131 patients (9.92%) progressed to acute myeloid leukemia (AML). 157 patients (54.5%) had one or more NRBC in their peripheral smear prior to their diagnostic BM examination. 27 out of these 157 patients (17.19%) progressed to AML. Survival in days was available in 59 patients. 19 out of 59 patients had undetectable NRBC in their peripheral smear prior to their initial diagnostic BM examination with an average survival of 1,256.2 days. Only one patient in this group underwent allogeneic matched unrelated peripheral stem cell transplantation (PSCT) with a survival of 2,532 days. 40 out of 59 patients had one or more NRBC in their peripheral smear prior to their diagnostic BM examination with an average survival of 850.4 days. Only 3 patients in this group underwent allogeneic matched PSCT (2 related and 1 unrelated) with an average survival of 924.3 days. Conclusions: The presence of nucleated red blood cells in the peripheral blood smear of patients with MDS seems to be a marker of more aggressive disease, higher rates of progression to AML and portends worse survival. To our knowledge this is the first study documenting the prognostic implication of NRBC in the peripheral circulation of patients with MDS. Disclosures: No relevant conflicts of interest to declare.

The immunoregulatory function of peripheral blood CD71+ erythroid cells in systemic-onset juvenile idiopathic arthritis

“…The positive correlation between erythropoietin levels and the amount of PBCECs also suggests the potential contribution of stress erythropoiesis to the expansion of CECs in autoinflammatory diseases. Several studies have reported that the expansion of PBCECs was related to a high mortality or disease severity 5 , 7 – 9 . Macrophage activation syndrome, an extremely severe manifestation of systemic inflammation with cytokine storm, occurs more frequently in SoJIA than in KD.…”

“…CECs thus cannot be found in the peripheral blood of healthy infants, children, or adults. Peripheral blood CECs (PBCECs) have been observed in pathological settings of hematological disorders 5 , solid tumors 6 , acute respiratory distress syndrome 7 , cardiovascular diseases 8 , and sepsis 9 . Many studies have mentioned the link between increased numbers of PBCECs and serious conditions or poor prognoses 5 – 9 .…”