Kahl C, Florschütz A, Müller G, Jentsch-Ullrich K, Arland M, Leuner S, Franke A, Höffkes H G
Department of Medicine, Otto-von-Guericke University of Magdeburg, Germany.
Ann Hematol. 1997 Sep;75(3):91-4. doi: 10.1007/s002770050320.
The detection of dysplastic features of hematopoiesis in de novo acute myeloid leukemia (AML) by light microscopy is defined as AML with trilineage myelodysplasia (AML/TLMD). The prognostic relevance of these dysplastic features for patients with de novo AML remains unclear. In order to evaluate the role of dysplasia in de novo AML, bone marrow aspirates from 69 patients were analyzed prospectively and investigated separately for erythropoiesis, granulopoiesis and megakaryopoiesis by three independent investigators. The overall complete remission (CR) rate was 48.8% and partial remission (PR) or nonresponders constituted 52.2% of the patients investigated. The median overall survival time was 5 months with a disease-free interval of 3.5 months for all patients. Dysgranulopoiesis (DysG) was observed in 30.4%, dysmegakaryopoiesis (DysM) in 50.7%, and dyserythropoiesis (DysE) in 43.5%. Of all patients, 26.0% showed trilineage dysplastic features and were thus classified as AML/TLMD. A significantly worse prognosis (Kaplan-Meyer plot, Student's t-test) was calculated for those patients with detection of only DysG (p = 0.002), DysM (p = 0.02), DysE (p = 0.04) as compared with patients without any dysplastic signs. An unfavorable karyotype was correlated with patients showing DysG (P = 0.02) and DysM (P = 0.04). For these patients with an unfavorable karyotype, the occurrence of any dysplastic features had no additional prognostic impact. Dysplastic features (DysG, DysM, DysE) seem to be an important prognostic factor in de novo AML correlating with short overall survival. DysG and DysM correlated well with the appearance of unfavorable chromosomal abnormalities. It may be reasonable to assume that patients with dysplastic features should be considered for more aggressive treatment schedules at the time of diagnosis.
通过光学显微镜检测初发急性髓系白血病（AML）中造血异常特征被定义为伴有三系骨髓发育异常的AML（AML/TLMD）。这些发育异常特征对初发AML患者的预后相关性仍不明确。为了评估发育异常在初发AML中的作用，对69例患者的骨髓穿刺液进行了前瞻性分析，并由三位独立研究者分别对红系造血、粒系造血和巨核系造血进行研究。总体完全缓解（CR）率为48.8%，部分缓解（PR）或无反应者占所研究患者的52.2%。所有患者的中位总生存时间为5个月，无病生存期为3.5个月。观察到30.4%存在粒系发育异常（DysG），50.7%存在巨核系发育异常（DysM），43.5%存在红系发育异常（DysE）。所有患者中，26.0%表现出三系发育异常特征，因此被归类为AML/TLMD。与无任何发育异常体征的患者相比，仅检测到DysG（p = 0.002）、DysM（p = 0.02）、DysE（p = 0.04）的患者预后明显更差（Kaplan - Meyer曲线，Student t检验）。不良核型与表现出DysG（P = 0.02）和DysM（P = 0.04）的患者相关。对于这些具有不良核型的患者，任何发育异常特征的出现没有额外的预后影响。发育异常特征（DysG、DysM、DysE）似乎是初发AML中与总生存时间短相关的重要预后因素。DysG和DysM与不良染色体异常的出现密切相关。可以合理推测，在诊断时应考虑对具有发育异常特征的患者采用更积极的治疗方案。
