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Annals of Hematology

, Volume 98, Issue 5, pp 1127–1133 | Cite as

Comparison of blast percentage calculated based on bone marrow all nucleated cells and non-erythroid cells in myelodysplastic syndromes with erythroid hyperplasia

  • Kiyomi Mashima
  • Takashi Ikeda
  • Shin-ichiro Kawaguchi
  • Yumiko Toda
  • Shoko Ito
  • Shin-ichi Ochi
  • Takashi Nagayama
  • Kento Umino
  • Daisuke Minakata
  • Hirofumi Nakano
  • Ryoko Yamasaki
  • Kaoru Morita
  • Yasufumi Kawasaki
  • Miyuki Sugimoto
  • Yuko Ishihara
  • Masahiro Ashizawa
  • Chihiro Yamamoto
  • Shin-ichiro Fujiwara
  • Kaoru Hatano
  • Kazuya Sato
  • Iekuni Oh
  • Ken Ohmine
  • Kazuo Muroi
  • Yoshinobu KandaEmail author
Original Article
  • 148 Downloads

Abstract

It is controversial whether blast percentage based on all nucleated cells (ANC) or non-erythroid cells (NEC) more accurately reflects the prognosis of patients with myelodysplastic syndromes (MDS). We considered that the impact of blast percentage on survival should be similar in MDS with erythroid hyperplasia (MDS-E) and MDS with no erythroid hyperplasia (MDS-NE), and from this perspective, we retrospectively analyzed 322 patients, including 44 with MDS-E and 278 with MDS-NE. Overall survival was similar between the MDS-E and MDS-NE groups (P = 0.94). In a subgroup of patients with bone marrow (BM) blasts of < 5%, no difference in survival was found between MDS-E and MDS-NE by either calculation method. However, in patients with a blast percentage between 5 and 10%, a significant difference in survival was observed only when the blast percentage in MDS-E was calculated from ANC (P < 0.001 by ANC and P = 0.66 by NEC). A similar result was observed when we analyzed the remaining patients with higher blasts together with those with blasts between 5 and 10%. These results suggest that the calculation of the BM blast percentage based on NEC in MDS-E provides a blast percentage value with a clinical impact consistent with that in MDS-NE.

Keywords

Myelodysplastic syndromes (MDS) Erythroid hyperplasia Non-erythroid cells (NEC) Acute myeloid leukemia (AML) 

Notes

Author’s contribution

KM performed the research, collected, and analyzed the data. YK performed the research and analyzed the data. All the authors wrote the paper and approved the final version.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this retrospective study, formal informed consent is not required. This study was approved by the ethics committee of Jichi Medical University.

Supplementary material

277_2018_3560_MOESM1_ESM.pptx (75 kb)
Figure. S1 Comparison of survival between MDS-E and MDS-NE calculated from ANC (a) (median OS, 121 months vs 171 months; P=0.60), and that calculated from NEC (b) (median OS, 121 months vs 171 months; P=0.45) in patients with a low blast percentage (<5%). (PPTX 74 kb)
277_2018_3560_MOESM2_ESM.pptx (119 kb)
Figure. S2 Comparison of time to AML transformation between MDS-E and MDS-NE calculated from ANC (a) (median time to 25% AML transformation, 24.1 months vs 141 months; P = 0.18), and that calculated from NEC (b) (median time to 25% AML transformation, NA vs 141 months; P = 0.81) in patients with a low blast percentage (<5%). Comparison of time to AML transformation between MDS-E and MDS-NE calculated from ANC (c) (median time to 25% AML transformation, 1.58 months vs 8.08 months; P=0.015), and that calculated from NEC (d) (median time to 25% AML transformation, 19.2 vs 10.1 months; P=0.71) in patients with a blast percentage between 5% to 10%. Comparison of time to 25% AML transformation between MDS-E and MDS-NE calculated from ANC (e) (median time to 25% AML transformation, 1.58 months vs 5.65 months; P=0.029), and that calculated from NEC (f) (median time to 25% AML transformation, 5.29 vs 6.11 months; P=0.58) in patients with a high blast percentage (5%≤). (PPTX 119 kb)
277_2018_3560_MOESM3_ESM.pptx (60 kb)
Figure. S3 Comparison of survival between IPSS low risk and high risk from ANC method (median OS from ANC method, low-risk vs high-risk, 117 months vs 14.0 months; P<0.001). (PPTX 59 kb)
277_2018_3560_MOESM4_ESM.pptx (77 kb)
Figure. S4 Comparison of survival between MDS-E and MDS-NE at low risk from ANC method (median OS, 121 months vs 117 months; P=0.34) (a), and from NEC method (median OS, 121 months vs 117 months; P=0.21) (b). (PPTX 76 kb)
277_2018_3560_MOESM5_ESM.pptx (181 kb)
Figure. S5 We performed the additional analyses including patients with AML who were excluded from the MDS cohort according to the WHO 2008 classification. Comparison of survival between MDS-E and MDS-NE calculated from ANC (median OS, 121 months vs 171 months; P=0.44), and that calculated from NEC (median OS, 121 months vs 171 months; P=0.45) in patients with a low blast percentage (<5%) (a). Comparison of time to AML transformation between MDS-E and MDS-NE calculated from ANC (median time to 25% AML transformation, 24.1 months vs 141 months; P=0.087), and that calculated from NEC (median time to 25% AML transformation, NA months vs 141 months; P=0.81) in patients with a low blast percentage (<5%) (b). Comparison of survival between MDS-E and MDS-NE calculated from ANC (median OS, 6.97 months vs 24.5 months; P<0.001), and that calculated from NEC (median OS, 39.7 months vs 39.5 months; P=0.93) in patients with a blast percentage between 5% to 10% (c). Comparison of time to AML transformation between MDS-E and MDS-NE calculated from ANC (median time to 25% AML transformation, 1.58 months vs 8.08 months; P=0.024), and that calculated from NEC (median time to 25% AML transformation, 19.2 months vs 10.1 months; P=0.71) in patients with a blast percentage between 5% to 10% (d). Comparison of survival between MDS-E and MDS-NE calculated from ANC (median OS, 7.65 months vs 18.6 months; P=0.031), and that calculated from NEC (median OS, 22.8 months vs 23.6 months; P=0.50) in patients with a high blast percentage (5%≤) (e). Comparison of time to AML transformation between MDS-E and MDS-NE calculated from ANC (median time to 25% AML transformation, 2.07 months vs 5.65 months; P=0.0039), and that calculated from NEC (median time to 25% AML transformation, 2.33 months vs 6.11 months; P=0.50) in patients with a high blast percentage (5%≤) (f). (PPTX 181 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Kiyomi Mashima
    • 1
  • Takashi Ikeda
    • 1
  • Shin-ichiro Kawaguchi
    • 1
  • Yumiko Toda
    • 1
  • Shoko Ito
    • 1
  • Shin-ichi Ochi
    • 1
  • Takashi Nagayama
    • 1
  • Kento Umino
    • 1
  • Daisuke Minakata
    • 1
  • Hirofumi Nakano
    • 1
  • Ryoko Yamasaki
    • 1
  • Kaoru Morita
    • 1
  • Yasufumi Kawasaki
    • 1
  • Miyuki Sugimoto
    • 1
  • Yuko Ishihara
    • 1
  • Masahiro Ashizawa
    • 1
  • Chihiro Yamamoto
    • 1
  • Shin-ichiro Fujiwara
    • 1
  • Kaoru Hatano
    • 1
  • Kazuya Sato
    • 1
  • Iekuni Oh
    • 1
  • Ken Ohmine
    • 1
  • Kazuo Muroi
    • 1
  • Yoshinobu Kanda
    • 1
    Email author
  1. 1.Division of Hematology, Department of MedicineJichi Medical UniversityShimotsuke-shiJapan

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