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Reply to ‘Quantification of marrow CD34+ cells: an important tool for distinguishing between hypoplastic myelodysplastic syndromes and aplastic anemia’ by A Orazi

Leukemia volume 20, pages 2041–2042 (2006)Cite this article

The intent of our study1, 2 was not to displace previous reports (including the one authored by Dr Orazi),3 but rather to provide further evidence that quantification of CD34+ cells can serve as a useful discriminator between aplastic anemia (AA) and hypoplastic myelodysplastic syndrome (hMDS). Dr Orazi is, in fact, misquoting our paper when he states that we imply that his group did not observe significant differences between the two groups. We acknowledge throughout our paper that the study of Orazi et al.2 demonstrated a significant difference in the mean percentage of CD34+ cells from patients classified as having either hMDS or AA. Further, our statement that there is overlap in the range of values given for the hMDS group is quite accurate, with a lower limit (0.1%) in these patients that is equal to the upper value given for those in the AA group. A potential confounding factor in their analysis may have come from reliance on the FAB guidelines to accurately diagnose patients, as those patients with normal cytogenetics and erythroid dysplasia as the sole morphologic abnormality may have in fact have had AA.

Despite the paper published 9 years ago by Dr Orazi and co-workers, enumeration of CD34 in the marrow has not become a standard test for what remains a clinical dilemma, distinguishing AA from hMDS. This is in part, we believe, because CD34 numbers, although statistically different between the disease groups, showed considerable overlap in several studies. Rather than attempting to ‘reinvent the wheel,’ we believe that our results build upon past studies by providing clinical outcomes that improve the ability to classify patients with either disease state. When doing this, we find no overlap in marrow CD34 numbers between AA and hMDS, and thus believe quantifying marrow CD34 numbers should be further tested as a standard approach for separating the two disorders. Furthermore, these findings also suggest that patients with normal cytogenetics and low CD34+ percentages are at a low risk of disease progression and may be managed in a conservative manner in the absence of life-threatening cytopenias.

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References

  1. Orazi A . Quantification of marrow CD34+ cells: an important tool for distinguishing between hypoplastic myelodysplastic syndromes and aplastic anemia. Leukemia 2006.

  2. Matsui WH, Brodsky RA, Smith BD, Borowitz MJ, Jones RJ . Quantitative analysis of bone marrow CD34 cells in aplastic anemia and hypoplastic myelodysplastic syndromes. Leukemia 2006; 20: 458–462.

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  3. Orazi A, Albitar M, Heerema NA, Haskins S, Neiman RS . Hypoplastic myelodysplastic syndromes can be distinguished from acquired aplastic anemia by CD34 and PCNA immunostaining of bone marrow biopsy specimens. Am J Clin Pathol 1997; 107: 268–274.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    W H Matsui, B D Smith & R J Jones

  2. Department of Medicine, Division of Hematology, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    R A Brodsky

  3. Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    M J Borowitz

Authors
  1. W H Matsui
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  2. R A Brodsky
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  3. B D Smith
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  4. M J Borowitz
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  5. R J Jones
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Correspondence to W H Matsui.

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Matsui, W., Brodsky, R., Smith, B. et al. Reply to ‘Quantification of marrow CD34+ cells: an important tool for distinguishing between hypoplastic myelodysplastic syndromes and aplastic anemia’ by A Orazi. Leukemia 20, 2041–2042 (2006). https://doi.org/10.1038/sj.leu.2404394

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