Refractory anemia in childhood: a retrospective analysis of 67 patients with particular reference to monosomy 7.
Primary myelodysplasia (MDS) without an increased number of blasts is a rare finding in childhood. We performed a retrospective analysis of 67 children with a diagnosis of primary MDS to determine the clinical and hematologic course of the disease. The median age at diagnosis was 8.3 years (range, 0.3-18.1 years). In contrast to refractory anemia in adults, 44% of patients had hemoglobin levels greater than 10 g/100 mL. The median white blood cell count and the absolute neutrophil count were 3.6 x 109/L and 0.9 x 109/L, respectively. Seventy-five percent of patients had thrombocytopenia. Bone marrow was hypocellular in 43% of the patients. Results of cytogenetic analysis showed monosomy 7 in 49%, trisomy 8 in 9%, and other abnormalities in 9% of the patients. The probability of survival 10 years after diagnosis was 0.48 (standard error [SE] = 0.10). Patients with monosomy 7 had significantly higher estimated probabilities of progression to advanced MDS than did patients with other chromosomal anomalies or normal karyotype. Of the 67 children, 41 underwent allogeneic stem cell transplantation (SCT). Patients whose disease did not progress to advanced MDS before SCT had significantly greater probability of survival than patients who experienced progression (0.76 [SE = 0.09] vs 0.36 [SE = 0.16]). SCT improved the outcomes for patients with monosomy 7 and should be offered early in the course of the disease. Recommendations for best treatment options for children with other chromosomal abnormalities or normal karyotype may have to await results of prospective clinical trials.
Kardos
Gabriela
G
Division of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Mathildenstrasse 1, 79106 Freiburg, Germany. niemeyer@kikli.ukl.uni-freiburg.de
Baumann
Irith
I
Passmore
S Jane
SJ
Locatelli
Franco
F
Hasle
Henrik
H
Schultz
Kirk R
KR
Starý
Jan
J
Schmitt-Graeff
Annette
A
Fischer
Alexandra
A
Harbott
Jochen
J
Chessells
Judith M
JM
Hann
Ian
I
Fenu
Susanna
S
Rajnoldi
Angelo Cantú
AC
Kerndrup
Gitte
G
Van Wering
Elisabeth
E
Rogge
Tim
T
Nollke
Peter
P
Niemeyer
Charlotte M
CM
D000293:Adolescent; D000753:Anemia, Refractory / Q000235:genetics* / Q000401:mortality* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D002896:Chromosomes, Human, Pair 6; D002897:Chromosomes, Human, Pair 7; D002898:Chromosomes, Human, Pair 8; D018450:Disease Progression; D005260:Female; D006801:Humans; D007223:Infant; D007621:Karyotyping; D008297:Male; D009006:Monosomy; D009503:Neutropenia / Q000235:genetics / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D014314:Trisomy