Raymakers R, De Witte T, Joziasse J, Van der Lely N, Boezeman J, Haanen C
Department of Internal Medicine, University Hospital Nijmegen, The Netherlands.
Br J Haematol. 1991 May;78(1):35-41. doi: 10.1111/j.1365-2141.1991.tb04379.x.
In 153 consecutive patients with myelodysplastic syndrome (MDS) the prognostic value of FAB-classification, cytogenetics, Bournemouth score, a history of previous radio- or chemotherapy and in vitro bone marrow growth were retrospectively analysed, for both acute nonlymphocytic leukaemia (ANLL) development and survival. Thirty-eight of the 153 patients (25%) showed progression to ANLL, 63 (41%) died during the myelodysplastic phase due to infection or bleeding and three (2%) received allogeneic bone marrow transplantation (BMT). Univariate analysis showed that the FAB-classification, in vitro growth pattern and differentiation, and cytogenetics had a predictive value for ANLL development and survival. The Bournemouth score was predictive only for survival. Most predictive for the development of ANLL were in vitro growth pattern and maturation. Patients with normal in vitro growth progressed to ANLL in 6% of the cases, in patients with hypoplastic or leukaemic growth 32.5% developed ANLL (P less than 0.0001). The ANLL incidence in patients with normally differentiated in vitro colonies was 14.5%, compared with a 52% incidence in cases showing no in vitro cell maturation (P = 0.001). The combination of growth pattern and differentiation revealed an ANLL incidence of 4.2% in cases of normal growth and differentiation, and 60.4% if the in vitro growth and/or differentiation was abnormal (P = 0.006). In vitro maturation was the only parameter predictive for ANLL development in multivariate analysis. From our data it is concluded that the predictive value of in vitro bone marrow culturing in patients with MDS can be increased by including in vitro maturation as a distinct parameter. The in vitro prognostic data can be important in selecting MDS patients for intensive chemotherapy or BMT.
对153例骨髓增生异常综合征（MDS）患者进行回顾性分析，以研究FAB分型、细胞遗传学、伯恩茅斯评分、既往放疗或化疗史及体外骨髓生长情况对急性非淋巴细胞白血病（ANLL）发生和生存的预后价值。153例患者中有38例（25%）进展为ANLL，63例（41%）在骨髓增生异常阶段因感染或出血死亡，3例（2%）接受了异基因骨髓移植（BMT）。单因素分析显示，FAB分型、体外生长模式和分化以及细胞遗传学对ANLL的发生和生存具有预测价值。伯恩茅斯评分仅对生存有预测价值。对ANLL发生最具预测性的是体外生长模式和成熟度。体外生长正常的患者中6%进展为ANLL，体外生长低下或白血病样生长的患者中32.5%发生ANLL（P<0.0001）。体外集落分化正常的患者中ANLL发生率为14.5%，而体外无细胞成熟的患者中发生率为52%（P = 0.001）。生长模式和分化的组合显示，生长和分化正常的病例中ANLL发生率为4.2%，而体外生长和/或分化异常的病例中为60.4%（P = 0.006）。多因素分析中，体外成熟是唯一对ANLL发生有预测价值的参数。从我们的数据可以得出结论，将体外成熟作为一个独立参数纳入分析，可以提高MDS患者体外骨髓培养的预测价值。体外预后数据对于选择MDS患者进行强化化疗或BMT可能很重要。
