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Clinical relevance of bone marrow fibrosis and CD34-positive cell clusters in primary myelodysplastic syndromes
Journal of Clinical Oncology, 12/30/08

Della Porta MG et al. - In a trial to assess bone marrow (BM) histologic abnormalities in myelodysplastic syndromes (MDS) classified according to WHO criteria to determine their clinical correlates and prognostic value, it was found that BM fibrosis identifies a distinct subgroup of MDS with multilineage dysplasia, high transfusion requirement, and poor prognosis and represents an independent prognostic factor that may be useful in clinical decision making. The presence of CD34+ cell clusters is an independent risk factor for progression to acute leukemia.

Methods

301 consecutive pts were retrospectively evaluated for BM fibrosis and CD34 immunoreactivity.
Marrow fibrosis was assessed following the European consensus guidelines.

Results

Moderate to severe BM fibrosis was detected in 17% of cases and was associated with multilineage dysplasia, high transfusion requirement, and poor-risk cytogenetics.
CD34+ cell clusters were found in 23% of pts and were associated with WHO categories with excess of blasts and poor-risk cytogenetics.
In multivariable analysis, BM fibrosis and presence of CD34+ cell clusters had independent negative impact on overall (OS) and leukemia-free survival (LFS).
Hierarchical clustering analysis identified 3 subsets of pts with distinct clinical features
1 cluster consisted mainly of pts with BM fibrosis, multilineage dysplasia, and high transfusion requirement; these individuals had lower OS and LFS.
Within pts stratified according to International Prognostic Scoring System and WHO classification–based Prognostic Scoring System categories, BM fibrosis involved a shift to a 1-step more advanced risk group.

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