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“Blasts” in myeloid neoplasms – how do we define blasts and how do we incorporate them into diagnostic schema moving forward?

Leukemia volume 36, pages 327–332 (2022)Cite this article

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We document blast percentage in every bone marrow report, and it influences the diagnosis and classification of hematopoietic neoplasms and subsequent management of patients. Given the critical role of blast percentage in disease definition [1], it is worthwhile to revisit and question the prime status of “blast” in hematopoietic diseases.

In bone marrow samples, defining a “blast” and quantifying “blasts” in a reproducible manner are challenging to hematopathologists. What is a blast? We use terms such as myeloblast, monoblast, erythroblast, lymphoblast, centroblast, immunoblast, plasmablast, etc. Some of the common characteristics of blasts include high nuclear:cytoplasmic ratio, fine or open chromatin, prominent nucleoli, and proliferative capacity. However, blasts can have different morphologic appearances, making it challenging to distinguish blasts from other normal precursors in day-to-day practice. Blast is rarely used outside of hematopathology; when used, it is used in the context of embryonic development or is used to describe “primitive” malignant tumors; examples being neuroblastoma, nephroblastoma, and a few others. Blast identification and enumeration is possibly not a significant indication in these situations.

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Fig. 1: Different cell types reside in CD45 versus side scatter-defined blast gate.
Fig. 2: Blasts may reside outside of CD45 versus side scatter-defined blast gate.
Fig. 3: Improved approaches to incorporate “blast” percentage in disease classification and stratification.

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Authors and Affiliations

  1. Division of Hematopathology, Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA, USA

    Xueyan Chen, Jonathan R. Fromm & Kikkeri N. Naresh

  2. Section of Pathology, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Kikkeri N. Naresh

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XC and KN wrote the manuscript and developed the figures and table. JF provided critical inputs.

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Correspondence to Kikkeri N. Naresh.

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Chen, X., Fromm, J.R. & Naresh, K.N. “Blasts” in myeloid neoplasms – how do we define blasts and how do we incorporate them into diagnostic schema moving forward?. Leukemia 36, 327–332 (2022). https://doi.org/10.1038/s41375-021-01498-6

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