Serial morphologic observation of bone marrow in aplastic anemia in children.
Recent reports of myelodysplastic syndrome/acute myeloid leukemia (t-MDS/AML) developing after treatment with immunosuppressants and granulocyte colony-stimulating factor (G-CSF) has raised the question of whether previously unrecognized myelodysplastic features had been present or whether actual transformation had occurred. We undertook a multi-institutional study of 112 children with aplastic anemia diagnosed between 1976 and 1996 and then treated with immunosuppressants with or without G-CSF. In each case, bone marrow specimens were tested at study entry and every 6 months for 3 years to detect t-MDS/AML as defined by morphologic and molecular/cytogenetic criteria. As of December 2001, all eligible patients had been followed for a median of 3 years. Morphologic abnormalities were found in 17 cases. The patients in 4 of these cases had clonal cytogenetic abnormalities and received MDS diagnoses. The morphologic features of the patients with and without clonal cytogenetic abnormalities were indistinguishable. However, the mast cell content was lower in cases with cytogenetic abnormalities than in cases without them. An elucidation of the role of mast cells may provide information about the differences between aplastic anemia and MDS or about the transition of aplastic anemia to MDS.
Bessho
Fumio
F
Department of Pediatrics, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan. bessho@kyorin-u.ac.jp
Imashuku
Shinsaku
S
Hibi
Shigeyoshi
S
Tsuchida
Masahiro
M
Nakahata
Tatsutoshi
T
Miyazaki
Sumio
S
Kojima
Seiji
S
Tsukimoto
Ichiro
I
Hamajima
Nobuyuki
N
D000741:Anemia, Aplastic / Q000188:drug therapy / Q000473:pathology*; D001853:Bone Marrow / Q000473:pathology*; D001856:Bone Marrow Examination; D002648:Child; D002869:Chromosome Aberrations; D018450:Disease Progression; D005500:Follow-Up Studies; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007951:Leukemia, Myeloid / Q000139:chemically induced / Q000175:diagnosis; D008407:Mast Cells / Q000473:pathology; D009190:Myelodysplastic Syndromes / Q000139:chemically induced / Q000175:diagnosis
D007166:Immunosuppressive Agents; D016179:Granulocyte Colony-Stimulating Factor