Raymakers R, Preijers F, Boezeman J, Rutten E, De Witte T
Department of Hematology, University Hospital Nijmegen, The Netherlands.
Leuk Lymphoma. 1994 Jun;14(1-2):111-20. doi: 10.3109/10428199409049656.
To assess the predictive role of bone marrow culturing in MDS in vitro data of 205 patients were correlated with progression to AML and survival. Both in vitro growth pattern and in vitro differentiation were significantly predictive for progression to AML. Other predictive parameters were FAB classification and the presence of cytogenetic abnormalities in all metaphases analysed. Since FAB classification and in vitro bone marrow culturing appeared confounding variables, the in vitro data were analysed for high risk patients, RAEB and RAEBt and low risk patients, RA and RARS. In 91/110 RAEB(t) patients the estimated chance to develop AML was 25% in cases of normal growth versus 62% if abnormal (p < 0.06). In 82/87 RA(RS) patients the estimated chance to develop AML was 5% and 40% respectively (p = 0.0004). After AML progression median survival was only 2 months (0-16.1 months). In RAEB(t) patients bone marrow culturing did not discriminate for better survival, although a trend was shown. The estimated median survival was 16 months if growth was normal versus 8 months if abnormal (p = 0.07). In RA(RS) patients the median survival also was not significantly different, 31 versus 22 months respectively (p = 0.39). However, if in vitro growth and differentiation were both normal a significant difference in median survival was observed, 35 versus 22 months (p = 0.016). In conclusion, in vitro bone marrow culturing has predictive value for AML development in RA(RS) patients. In RAEB(t), due to many patients dying early in cytopenia, the predictive value is less pronounced. Especially normal growth in RA(RS) patients makes progression to AML very unlikely and these patients should be considered for a supportive approach. In RA(RS) patients with normal growth and differentiation (about 25% of all patients) in vitro bone marrow culturing also predicts a better survival.
为评估骨髓培养在骨髓增生异常综合征（MDS）中的预测作用，对205例患者的体外数据与进展为急性髓系白血病（AML）及生存情况进行了相关性分析。体外生长模式和体外分化对进展为AML均具有显著预测价值。其他预测参数包括FAB分类以及所有分析中期细胞中的细胞遗传学异常情况。由于FAB分类和体外骨髓培养似乎是混杂变量，因此对高危患者（RAEB和RAEBt）和低危患者（RA和RARS）的体外数据进行了分析。在91/110例RAEB(t)患者中，生长正常者进展为AML的估计概率为25%，异常者为62%（p<0.06）。在82/87例RA(RS)患者中，进展为AML的估计概率分别为5%和40%（p = 0.0004）。进展为AML后，中位生存期仅为2个月（0 - 16.1个月）。在RAEB(t)患者中，骨髓培养对生存期改善并无区分作用，尽管呈现出一种趋势。生长正常者估计中位生存期为16个月，异常者为8个月（p = 0.07）。在RA(RS)患者中，中位生存期也无显著差异，分别为31个月和22个月（p = 0.39）。然而，如果体外生长和分化均正常，则观察到中位生存期存在显著差异，分别为35个月和22个月（p = 0.016）。总之，体外骨髓培养对RA(RS)患者进展为AML具有预测价值。在RAEB(t)患者中，由于许多患者在血细胞减少期早期死亡，其预测价值不太明显。特别是RA(RS)患者生长正常时，进展为AML的可能性非常小，这些患者应考虑采用支持性治疗方法。在生长和分化均正常的RA(RS)患者中（约占所有患者的25%），体外骨髓培养也预示着更好的生存情况。
