Tassin et al developed an index for predicting survival in patients with a myelodysplastic syndrome based on changes seen on bone marrow examination. This can help identify those patients requiring more aggressive management. The authors are from the University of Liege and Hopital de Jolmont in Belgium.
Parameters:
(1) percent erythroid cells showing megaloblastosis
(2) percent granulocytes showing hypogranularity (grades 2 or 3 hypogranulation)
(3) percent granulocytes showing agranularity (grade 0)
(4) percent granulocytes showing acquired Pelger-Huet anomaly (bilobated, band--like or monolobated)
|
Parameter
|
Finding
|
Points
|
|
erythroid cells showing megaloblastosis
|
<= 50%
|
0
|
|
|
> 50%
|
1
|
|
granulocytes showing hypogranularity
|
<= 5%
|
0
|
|
|
> 5%
|
1
|
|
granulocytes showing agranularity
|
<= 10%
|
0
|
|
|
> 10%
|
1
|
|
granulocytes with the Pelger-Huet anomaly
|
<= 4%
|
0
|
|
|
> 4%
|
1
|
where:
• The megaloblastosis should not be due to vitamin B12 or folate deficiencies.
• The patient should not have congenital Pelger-Huet anomaly.
• The criteria for granulocyte appearance are those of Widell et al.
• Table II page 488 has the cutoffs for agranularity was > 5% and hypogranularity as > 10%, which is the opposite as that given in the text on the same page.
• Agranular and hypogranular granulocytes appear to be counted separately.
dysplasia index =
= (1.26 * (points for megaloblastosis)) + (0.82 * (points for agranularity)) - (1.08 * (points for hypogranularity)) + (0.45 * (points for Pelger-Huet))
Interpretation:
• minimum index: -1.08
• maximum index: 2.53
• A DI <= 0 had a median survival of 2.6 years, while a DI > 0 had a median survival of 1.1 years.
|
Dysplasia Index
|
Positive Findings
|
Median Survival
|
|
-1.08
|
hypogranularity
|
5.1 years
|
|
-0.26, -0.63 or 0
|
none, hypogranularity + Pelger-Huet, hypogranularity + agranularity
|
2.3 years
|
|
0.18, 0.19
|
hypogranularity + megaloblastosis, hypogranularity + Pelger-Huet + agranularity
|
1.7 years
|
|
> 0.19 (>= 0.45)
|
all other combinations (10)
|
0.5 years
|
where:
• In the caption to Figure 1, page 490 (megaloblastosis + hypogranularity, DI 0.18) would be listed in the poor survival group as one of the "all other combinations". However, I suspect it really belongs with DI 0.19 as intermediate.
