Bone marrow histology in myelodysplastic syndromes. II. Prognostic value of abnormal localization of immature precursors in MDS.

A study has been performed of 40 bone marrow trephine biopsies from patients with myelodysplastic syndromes (MDS). Histology, more specifically the abnormal localization of immature precursors (ALIP), cytology and karyotype analysis were correlated with survival time and the prognostic value of these factors was determined. The presence or absence of ALIP proved to be highly significant in predicting the duration of survival (P = 0.007): the presence of ALIP predisposes patients to early death with high probability of developing acute myeloid leukaemia (AML), whereas the absence of ALIP carries a better prognosis with more long-term survivors and low probability of transformation to AML. The presence or absence of ALIP was not correlated with increased mortality from infection and/or bleeding. In contrast with ALIP, the main histological parameter, we were not able to obtain statistically significant prognostic information for cytology (FAB classification) or karyotype analysis (normal or abnormal chromosomes). We conclude that bone marrow biopsy provides useful information for the prognosis of MDS and that the presence of ALIP has greater predictive value than the more commonly used parameters deduced from cytology and karyotype.