title: Having a higher blast percentage in circulation than bone marrow: clinical implications in myelodysplastic syndrome and acute lymphoid and myeloid leukemias.
abstract: Determining the percentage of peripheral blood (PB) and bone marrow (BM) blasts is important for diagnosing and classifying acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). Although most patients with acute leukemia or MDS have a higher percentage of BM blasts than PB blasts, the relative proportion is reversed in some patients. We explored the clinical relevance of this phenomenon in MDS (n = 446), AML (n = 1314), and acute lymphoblastic leukemia (ALL) (n = 385). Among patients with MDS or ALL, but not AML, having a higher blast percentage in PB than in BM was associated with significantly shorter survival. In multivariate analyses, these associations were independent of other relevant predictors, including cytogenetic status. Our findings suggest that MDS and ALL patients who have a higher percentage of PB blasts than BM blasts have more aggressive disease. These data also suggest that MDS classification schemes should take into account the percentage of blasts in PB differently from the percentage of blasts in BM.
authors.affiliation: Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: H M
authors.initials: HM
authors.lastname: Amin
authors.forename: Y
authors.initials: Y
authors.lastname: Yang
authors.forename: Y
authors.initials: Y
authors.lastname: Shen
authors.forename: E H
authors.initials: EH
authors.lastname: Estey
authors.forename: F J
authors.initials: FJ
authors.lastname: Giles
authors.forename: S A
authors.initials: SA
authors.lastname: Pierce
authors.forename: H M
authors.initials: HM
authors.lastname: Kantarjian
authors.forename: S M
authors.initials: SM
authors.lastname: O'Brien
authors.forename: I
authors.initials: I
authors.lastname: Jilani
authors.forename: M
authors.initials: M
authors.lastname: Albitar
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001752:Blast Crisis / Q000097:blood* / Q000473:pathology; D001853:Bone Marrow / Q000098:blood supply*; D002648:Child; D005260:Female; D006801:Humans; D007945:Leukemia, Lymphoid / Q000097:blood* / Q000145:classification / Q000473:pathology; D007951:Leukemia, Myeloid / Q000097:blood* / Q000145:classification / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000097:blood* / Q000145:classification / Q000473:pathology; D012189:Retrospective Studies; D016019:Survival Analysis