Therapy-Related Myelodysplastic Syndrome: Morphologic Subclassification May Not Be Clinically Relevant

Singh, Zeba N.; Huo, Dezheng; Anastasi, John; Smith, Sonali M.; Karrison, Theodore; Beau, Michelle Le; Larson, Richard A.; Vardiman, James W.

doi:10.1309/8857-72r1-18t7-2h58

Cited by 36 publications

(57 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Patients with therapy-related AEL had a dismal prognosis confirming the clinical significance of classifying this type of AEL within the "therapy-related myeloid neoplasms" category which has a worse prognosis independently of clinical characteristics and morphological classification. 12,13 The median overall survival of the AEL patients with unfavorable cytogenetics was 6 months, similar to the 8-month median overall survival observed in a separate group of 41 patients with AML-MRC and 50% or more erythropoiesis. 6 The AEL patients with intermediate cytogenetics (most of whom would not classify as having MRC disease) had a much longer median overall survival (30 months).…”

supporting

confidence: 70%

Acute myeloid leukemia with expanded erythropoiesis

Porwit¹,

Vardiman²

2011

Haematologica

View full text Add to dashboard Cite

Depending on previous clinical history, number of blasts in the bone marrow, and results of cytogenetic analysis, hematologic malignancies with expanded erythropoiesis (more than 50% of bone marrow erythropoietic cells) may fall under various categories of the 2008 edition of the World Health Organization (WHO) classification of tumors of hematopoietic and lymphoid tissues (Table 1). 1The general threshold of blast percentage for the diagnosis of acute myeloid leukemia (AML) is 20% of total peripheral blood or bone marrow cells. However, cases with fewer than 20% blasts and more than 50% of erythroid precursors in the bone marrow are classified as acute erythroid leukemia (AEL, erythroid/myeloid) if blasts account for 20% or more of the non-erythroid cells. If blasts constitute less than 20% of nonerythroid cells, the cases are classified into various categories of myelodysplastic syndromes (MDS). Patients with 80% or more of bone marrow cells representing immature cells committed exclusively to the erythropoietic lineage are classified as having pure erythroid leukemia.The WHO 2008 classification has also defined the category of AML with myelodysplasia-related changes (AML-MRC) as acute leukemia with 20% or more peripheral blood or bone marrow blasts with morphological features of myelodysplasia or a prior history of MDS or MDS/myeloproliferative neoplasm or MDS-related genetic abnormalities (Table 2), and absence of prior cytotoxic therapy and the specific genetic abnormalities that would classify the case as AML with recurrent genetic abnormalities. Several studies confirmed the negative prognostic significance of the MDSrelated genetic abnormalities.2,3 Concerning cases with more than 50% erythroid precursors, the authors of the WHO 2008 classification stated that cases with 20% or more blasts should be classified as AML-MRC if MDS-related cytogenetic abnormalities or multilineage dysplasia in more than 50% of cells in two or more lineages are found. It has also been pointed out that patients with AEL often have complex karyotypes but the possibility of including AEL cases with complex karyotypes and less than 20% bone marrow blasts in the AML-MRC category has not been addressed. 1Several groups have recently discussed the diagnosis, definition and prognosis of AEL and MDS with expanded erythropoiesis (>50% erythropoietic precursors in bone marrow smears).4-6 The common findings were high incidence of unfavorable karyotypes, low frequency of NPM1, FLT3 and RAS mutations, and poor prognosis. 4,[6][7][8][9][10] In this issue of Haematologica, Bacher et al. 4 have compared some genetic and clinical aspects of AML and MDS with expanded erythropoiesis. On the basis of the observed better 2-year overall survival rate of MDS patients (n=104) in comparison to those classified as having AML (combined cohort of 77 AEL and 24 AML-MRC), the authors propose continuing separating MDS with expanded erythropoiesis from AML. It should be noted that the patients in this study classified as having MDS and carrying an unfavorab...

show abstract

supporting

confidence: 70%

Acute myeloid leukemia with expanded erythropoiesis

Porwit¹,

Vardiman²

2011

Haematologica

View full text Add to dashboard Cite

show abstract

“…Although cases may be designated as t-AML, or as t-MDS or t-MDS/MPN depending on the blast count, it is useful to think of them as a single biologic disease with similar genetic features, so that the designation as t-AML/t-MDS is appropriate as well. 94,95 Most patients who develop therapy-related myeloid neoplasms have received alkylating agents and/or radiation as well as topoisomerase II inhibitors, so that a division according to the type of therapy is usually not practical and is no longer recommended. It has been argued that 90% of patients with therapy-related neoplasms have cytogenetic abnormalities identical to those observed in AML with myelodysplasia-related features or in AML with recurrent cytogenetic abnormalities, therefore such cases would be more appropriately classified in those categories rather than in a separate, therapy-related category.…”

Section: Acute Myeloid Leukemia and Related Precursor Neoplasmsmentioning

confidence: 99%

The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes

Vardiman

Thiele

Arber

et al. 2009

Blood

3,904

3,157

View full text Add to dashboard Cite

1 That classification reflected a paradigm shift from previous schemes in that, for the first time, genetic information was incorporated with morphologic, cytochemical, immunophenotypic, and clinical information into diagnostic algorithms for the myeloid neoplasms. The 2001WHO classification was prefaced with a comment predicting that future revisions would be necessary because of rapidly emerging genetic and biologic information. Recently, a revised classification has been published as part of the 4th edition of the WHO monograph series. 2 The aim of the revision was to incorporate new scientific and clinical information to refine diagnostic criteria for previously described neoplasms and to introduce newly recognized disease entities. Our purpose in this communication is to highlight major changes in the revised WHO classification of myeloid neoplasms and acute leukemia and to provide the rationale for those changes.

show abstract

“…[8][9][10] This type of AML usually occurs after a median of 2 years, and is not preceded by a MDS. According to the French-American-British (FAB) classification, M4 and M5 subtypes are observed more frequently, and cytogenetic analysis shows a high frequency of rearrangements of chromosome band 11q23, t(8;21), t (15;17), inv (16) or t(8;16) as in de novo-AML. 10,11 Importantly the small number of patients with t-AML who have favorable cytogenetic abnormalities, such as t (8;21), t (15;17) or inv (16), have a considerably better outcome, not markedly different from that observed in patients with de novo AML with the same abnormalities.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for therapy-related myelodysplastic syndrome and acute myeloid leukemia treated with allogeneic stem cell transplantation

Kröger¹,

Brand²,

Biezen³

et al. 2009

Haematologica

113

101

View full text Add to dashboard Cite

The online version of this article contains a supplementary appendix. BackgroundAfter successful treatment of malignant diseases, therapy-related myelodysplastic syndrome and acute myeloid leukemia have emerged as significant problems. Design and MethodsThe aim of this study was to investigate outcome and risk factors in patients with therapy-related myelodysplastic syndrome or acute myeloid leukemia who underwent allogeneic stem cell transplantation. Between 1981 and 2006, 461 patients with therapy-related myelodysplastic syndrome or acute myeloid, a median age of 40 years and a history of solid tumor (n=163), malignant lymphoma (n=133), or other hematologic diseases (n=57) underwent stem cell transplantation and their data were reported to the European Group for Blood and Marrow Transplantation. ResultsThe cumulative incidence of non-relapse mortality and relapse at 3 years was 37% and 31%, respectively. In a multivariate analysis significant factors for relapse were not being in complete remission at the time of transplantation (p=0.002), abnormal cytogenetics (p=0.005), higher patients' age (p=0.03) and therapy-related myelodysplastic syndrome (p=0.04), while higher non-relapse mortality was influenced by higher patients' age. Furthermore, there was a marked reduction in non-relapse mortality per calendar year during the study period (p<0.001). The 3-year relapse-free and overall survival rates were 33% and 35%, respectively. In a multivariate analysis significant higher overall survival rates were seen per calendar year (p<0.001), for younger age (<40 years) and normal cytogenetics (p=0.05). Using age (<40 years), abnormal cytogenetics and not being in complete remission at the time of transplantation as risk factors, three different risk groups with overall survival rates of 62%, 33% and 24% could be easily distinguished. ConclusionsAllogeneic stem cell transplantation can cure patients with therapy-related myelodysplastic syndrome and acute myeloid leukemia and has markedly improved over time. Noncomplete remission, abnormal cytogenetics and higher patients' age are the most significant factors predicting survival.Key words: allogeneic stem cell transplantation, therapy-related, myelodysplastic syndrome, acute myelogenous leukemia, cytogenetic abnormalities. transplantation. Haematologica 2009; 94:542-549. doi:10.3324/haematol.2008 This is an open-access paper. Citation: Kröger N, Brand R, van Biezen A, Zander A, Dierlamm J, Niederwieser D, Devergie A, Ruutu T, Cornish J, Ljungman P, Gratwohl A, Cordonnier C, Beelen D, Deconinck E, Symeonidis A, de Witte T for the Myelodysplastic Syndromes Subcommittee of The Chronic Leukaemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT). Risk factors for therapy-related myelodysplastic syndrome and acute myeloid leukemia treated with allogeneic stem cell Risk factors for therapy-related myelodysplastic syndrome and acute myeloid leukemia treated with allogeneic stem cell transplantation

show abstract

Therapy-Related Myelodysplastic Syndrome: Morphologic Subclassification May Not Be Clinically Relevant

Cited by 36 publications

References 0 publications

Acute myeloid leukemia with expanded erythropoiesis

Acute myeloid leukemia with expanded erythropoiesis

The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes

Risk factors for therapy-related myelodysplastic syndrome and acute myeloid leukemia treated with allogeneic stem cell transplantation

Contact Info

Product

Resources

About