Gahn B, Haase D, Unterhalt M, Drescher M, Schoch C, Fonatsch C, Terstappen L W, Hiddemann W, Büchner T, Bennett J M, Wörmann B
Department of Internal Medicine, Georg-August-University, Göttingen, Germany.
Leukemia. 1996 Jun;10(6):946-51.
Dysplastic hematopoiesis is the morphological hallmark of myelodysplastic syndromes. Dysplastic features in one or more lineages are also found frequently in bone marrow aspirates from patients with de novo AML and have been associated with an unfavorable prognosis. We asked whether dyshematopoiesis is an independent prognostic factor or an indicator of unrecognized secondary leukemia, identified by characteristic chromosomal abnormalities. Bone marrow aspirates from 102 patients with newly diagnosed AML were analyzed. Morphological analysis was obtained in all patients, flow cytometric analysis in 96 and successful cytogenetic analysis in 65 bone marrow aspirates. Dysgranulopoiesis (DysG) was found in 55, dysmegakaryopoiesis (DysM) in 32 and dyserythropoiesis (DysE) in 23 patients. Decreased side scatter signals of neutrophils in the flow cytometric analysis (DysS) were detected in 32 patients. DysG and DysS showed a highly significant correlation (P = 0.0005). DysG was an adverse negative prognostic factor for remission rate and event-free survival (P = 0.04, P = 0.02). An unfavorable karyotype was associated with a significantly lower chance for event-free survival (P = 0.002). The incidence of an unfavorable karyotype was significantly higher in patients with DysG (P = 0.01), DysM (P = 0.02) and DysS (P = 0.01). In patients with an unfavorable karyotype, dysplasia had no additional prognostic influence, however, in patients with a normal, favorable or prognostically uncertain karyotype DysG remained a predictor of lower remission rate (P = 0.03). We conclude that dysgranulopoiesis, dysmegakaryopoiesis and decreased side scatter signals of neutrophils are indicators of secondary leukemias in bone marrow aspirates from patients with de novo AML.
发育异常的造血是骨髓增生异常综合征的形态学标志。在初发急性髓系白血病（AML）患者的骨髓穿刺物中，也经常发现一个或多个谱系的发育异常特征，并且与不良预后相关。我们探讨了造血异常是一个独立的预后因素还是未被识别的继发性白血病的指标，后者可通过特征性染色体异常来确定。对102例新诊断的AML患者的骨髓穿刺物进行了分析。所有患者均进行了形态学分析，96例进行了流式细胞术分析，65例骨髓穿刺物成功进行了细胞遗传学分析。55例患者发现有粒细胞生成异常（DysG），32例有巨核细胞生成异常（DysM），23例有红细胞生成异常（DysE）。32例患者在流式细胞术分析中检测到中性粒细胞侧向散射信号降低（DysS）。DysG和DysS显示出高度显著的相关性（P = 0.0005）。DysG是缓解率和无事件生存期的不良阴性预后因素（P = 0.04，P = 0.02）。不良核型与无事件生存期的机会显著降低相关（P = 0.002）。DysG（P = 0.01）、DysM（P = 0.02）和DysS（P = 0.01）患者中不良核型的发生率显著更高。在核型不良的患者中，发育异常没有额外的预后影响，然而，在核型正常、良好或预后不确定的患者中，DysG仍然是缓解率较低的预测指标（P = 0.03）。我们得出结论，粒细胞生成异常、巨核细胞生成异常和中性粒细胞侧向散射信号降低是初发AML患者骨髓穿刺物中继发性白血病的指标。
