title: A new disease categorization of low-grade myelodysplastic syndromes based on the expression of cytopenia and dysplasia in one versus more than one lineage improves on the WHO classification.
abstract: Multilineage dysplasia was advanced by the World Health Organization to increase prognostic accuracy in myelodysplastic syndromes (MDS) classification. We performed a structured cytomorphological examination of bone marrow (BM) in 221 low-grade MDS patients, this in conjunction with strict guidelines for cytopenias. A dysplasia scoring system was developed utilizing dysplastic changes, which were associated with worse outcome on univariate and multivariate analysis corrected for the International Prognostic Scoring System (IPSS). Dysplasia >or=10% in one BM lineage and one cytopenia constituted the low-risk category UCUD or Unilineage Cytopenia and Unilineage Dysplasia. The high-risk category comprised patients with cytopenia in >or=2 lineages and dysplasia in >or=2 BM lineages, namely MCMD or Multilineage Cytopenia and Multilineage Dysplasia. Intermediate-risk patients had one cytopenia and multilineage dysplasia, or cytopenia in >or=2 lineages and unilineage BM dysplasia, designated UCMD/MCUD or Unilineage Cytopenia and Multilineage Dysplasia/Multilineage Cytopenia and Unilineage Dysplasia. This system utilizing cytopenia-dysplasia scoring at diagnosis enabled comprehensive categorization of low-grade MDS cases that predicted for overall as well as leukemia-free survival. Cytopenia-dysplasia categorization added additional prognostic values to the lower risk IPSS categories. This suggests that a standardized dysplasia scoring system, used in conjunction with cytopenia, could improve diagnostic and prognostic sub-categorization of MDS patients.
authors.affiliation: Department of Hematology, University Hospitals, University of Leuven, Leuven, Belgium. estelle.verburgh@student.kuleuven.be
authors.forename: E
authors.initials: E
authors.lastname: Verburgh
authors.forename: R
authors.initials: R
authors.lastname: Achten
authors.forename: V J
authors.initials: VJ
authors.lastname: Louw
authors.forename: C
authors.initials: C
authors.lastname: Brusselmans
authors.forename: M
authors.initials: M
authors.lastname: Delforge
authors.forename: M
authors.initials: M
authors.lastname: Boogaerts
authors.forename: A
authors.initials: A
authors.lastname: Hagemeijer
authors.forename: P
authors.initials: P
authors.lastname: Vandenberghe
authors.forename: G
authors.initials: G
authors.lastname: Verhoef
mesh_terms: D000704:Analysis of Variance; D001853:Bone Marrow / Q000473:pathology; D001854:Bone Marrow Cells / Q000473:pathology; D007621:Karyotyping; D008534:Megaloblasts / Q000473:pathology*; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000145:classification* / Q000235:genetics / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis; D014944:World Health Organization