Altered neutrophil maturation patterns that limit identification of myelodysplastic syndromes.

Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Cytometry Part B Clinical Cytometry (Impact Factor: 2.23). 03/2012; 82(4):217-28. DOI: 10.1002/cyto.b.21016
Source: PubMed

ABSTRACT Altered neutrophil maturation patterns have been reported useful for identification of myelodysplastic syndromes (MDS).
Neutrophil maturation patterns based on CD11b, CD13, and CD16 were visually and numerically evaluated in 19 control, 23 MDS, 37 nondiagnostic for MDS (NDM) specimens, and 19 also processed 1 and 2 days subsequently.
In contrast to maturation patterns illustrated previously by others as "normal," 84% of controls displayed diminished acquisition of CD16, imparting a contracted appearance. Such divergence from published "normal" patterns was usually mild-moderate, considered nonspecific, and associated with delayed processing: longer intervals between collection and processing (median 20.5 vs. 5.2 h), and following 1 and 2 days delay. Findings restricted to nonspecific contraction were found in 56% MDS and 78% NDM specimens. Evaluation for aberrant patterns was still performed with mild-moderate contraction present, but concern for over interpretation led to use of an equivocal-aberrant category. Nine cases had aberrant or equivocal-aberrant patterns (seven MDS, two NDM) with distinct visual alterations that differed from nonspecific contraction and had numerical evidence for a left shift: myeloblasts increased (67%) and least mature neutrophils (CD11b-/low, CD16-/low) increased (78%). Although evidence for a left shift was associated with MDS, it was also seen in NDM specimens with a synchronous left shift.
Neutrophil maturation patterns that diverge from previously illustrated "normal" patterns, not specific for MDS, may be common in some settings. Laboratories seeking to implement FC evaluation for MDS must determine which findings have sufficient specificity for MDS within their own practice and patient population.

1 Bookmark
  • [Show abstract] [Hide abstract]
    ABSTRACT: ABSTRACT Lenalidomide (LEN) treatment in multiple myeloma (MM) results in superior outcome. However, there is concern for increased myelodysplastic syndromes/acute myeloid leukemias (MDS/AML) associated with LEN. Thus, bone marrow morphology and cytogenetic studies from 40 patients were evaluated for early signs of MDS prior to therapy, during therapy and at follow-up. Newly diagnosed MM patients treated with LEN and dexamethasone (LD) alone or followed by ASCT (LD/ASCT), or relapsed/refractory MM patients treated with LEN, bendamustine and dexamethasone (BLD) were included. One patient developed MDS. Baseline prevalence of mild morphologic myelodysplasia was highest in pretreated MM patients (BLD, 71%), but was also seen in newly diagnosed patients (LD and LD/ASCT, 17%). Prevalence of myelodysplasia did not increase over time. Thus, this study did not reveal rapidly emerging MDS in 39 of 40 MM patients treated with LEN. Development of MDS in one patient suggests that longer follow up is needed for all. Trials were registered at as #NCT00777881 and #NCT01042704.
    Leukemia & lymphoma 12/2012; 54(9). DOI:10.3109/10428194.2012.755177 · 2.61 Impact Factor

Full-text (2 Sources)

Available from
Nov 20, 2014