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  • Letter to the Editor
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Understanding the mutational evolution of clonal cytopenias and oligoblastic myelogenous leukemia (‘myelodysplasia’)

Leukemia volume 28, page 202 (2014)Cite this article

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In their comprehensive paper in this journal on clonal diversity in the myelodysplastic syndromes, Walter et al1 often used the term myelodysplasia to characterize patients, a broad designation implying varying stages of myelogenous leukemia. In their supplement, they did define, explicitly, selected patients they described with a category of myelodysplasia, such as refractory anemia or refractory anemia with excess blasts. The starting point of the individual cases of what I prefer to call clonal cytopenia and oligoblastic myelogenous leukemia may be critical in analyzing the effects of accumulating mutations on clonal evolution. For example, the mutational evolution that is required to transit the highly arbitrary, indeed imaginary, boundary of 20% marrow leukemic myeloblasts and become ‘acute myelogenous leukemia’ using the World Health Organization criterion may be different if one starts with a stable clonal anemia with 0.5% myeloblasts in the marrow or if one has multiple cytopenias and 9% myeloblasts in the diagnostic marrow. This information could be important in designing approaches to stabilize or treat the disorders in question.

Although much aggregate information was given on the phenotypic features of the cases studied in the paper, the correlation of the nature and extent of somatic mutations with the precise starting point of the patient’s neoplasm was somewhat general in the few individual cases so characterized in the supplement. This letter is not a criticism of an important paper containing much information. I write only to emphasize the importance of seeing this spectrum of myelogenous leukemia more integrally than is implied by the current classification. Explicit hematological and genetic information describing the starting point at which the mutational analysis occurred could be very informative. We do learn much about the various mutations involved; these studies are an important start. The 0.5% marrow blast cell count in the example of clonal anemia given above represents leukemic blast cells as well, as clonal hematopoiesis is the sole phenotype present in this situation in virtually all cases; this interpretation is also compatible with the aberrant immunophenotype of low proportions of blast cells in the marrow of patients with clonal cytopenias.

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References

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  1. Department of Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, USA,

    M A Lichtman

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  1. M A Lichtman
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Correspondence to M A Lichtman.

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Lichtman, M. Understanding the mutational evolution of clonal cytopenias and oligoblastic myelogenous leukemia (‘myelodysplasia’). Leukemia 28, 202 (2014). https://doi.org/10.1038/leu.2013.209

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