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Myelodisplasias

Improvement of criteria for refractory cytopenia with multilineage dysplasia according to the WHO classification based on prognostic significance of morphological features in patients with refractory anemia according to the FAB classification

Leukemia volume 21, pages 678–686 (2007)Cite this article

Abstract

In the criteria of refractory cytopenia with multilineage dysplasia (RCMD) according to the WHO (World Health Organization) classification, the frequency threshold concerning dysplasia of each lineage was defined as 10%. To predict overall survival (OS) and leukemia-free survival (LFS) for patients with refractory anemia (RA) according to the French-American-British (FAB) classification, we investigated prognostic factors based on the morphological features of 100 Japanese and 87 German FAB-RA patients, excluding 5q-syndrome. In the univariate analysis of all patients, pseudo-Pelger–Huet anomalies ⩾10% (Pelger+), micromegakaryocytes ⩾10% (mMgk+), dysgranulopoiesis (dys G) ⩾10% and dysmegakaryopoiesis (dys Mgk) ⩾40% were unfavorable prognostic factors for OS and LFS (OS; P<0.001, LFS; P<0.001). The prognostic effects of the morphological features were similar in both Japanese and German patients. However, dys Mgk ⩾10% was not correlated with OS and LFS. In the multivariate analysis, mMgk+ and dys Mgk⩾40% were adverse prognostic factors for OS for all patients, and dys G ⩾10% and dys Mgk⩾40% were adverse prognostic factors for LFS for all patients. On the basis of the present analysis, we propose the following modified morphological criteria for RCMD. Modified RCMD should be defined as FAB-RA, excluding 5q-syndrome with dys G ⩾10%, dys Mgk⩾40% or mMgk+.

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Acknowledgements

Supported in part by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (no. 16639013) (IJ) and Kompetenznetzwerk ‘Akute und Chronische Leukämien’ des Bundesforschungsministeriums.

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Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Saitama Medical University, Saitama, Japan

    A Matsuda, I Jinnai, M Misumi & M Bessho

  2. Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany

    U Germing, A Kuendgen, C Strupp & N Gattermann

  3. Department of Hematology, Molecular Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    M Iwanaga, Y Miyazaki, H Tsushima, M Sakai & M Tomonaga

  4. Department of Hematology, Oncology and Clinical Immunology, St Johannes Hospital, Duisburg, Germany

    C Aul

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  1. A Matsuda
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Correspondence to A Matsuda.

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Matsuda, A., Germing, U., Jinnai, I. et al. Improvement of criteria for refractory cytopenia with multilineage dysplasia according to the WHO classification based on prognostic significance of morphological features in patients with refractory anemia according to the FAB classification. Leukemia 21, 678–686 (2007). https://doi.org/10.1038/sj.leu.2404571

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