Examination of the bone marrow can be used to evaluate the prognosis in patients with primary myelodysplasia. This can be done independent of clinical and other laboratory data. This score was developed at the Medizinische Hochschule in Hannover, Germany.
Parameters used (defined on page 281):
(1) quantity of erythropoiesis
(2) dislocation of erythropoiesis: erythroid precursor cells in contact with bone trabeculae
(3) percentage of myeloblasts
(4) maturation arrest of granulopoiesis (used only if the number of myeloblasts was not increased)
(5) abnormal localization of immature precursors (ALIP): at least 3 clusters of myeloid precursors seen in one histologic section (level)
(6) atypia in megakaryopoiesis: presence of micromegakaryocytes or polynuclear megakaryocytes
(7) myelofibrosis
(8) mast cells
(9) siderin storage seen on iron stains
Parameters most important for prognosis: 3, 5, 7
|
Parameter |
Finding |
Points |
|---|---|---|
|
quantity of erythropoiesis |
strong increase |
0 |
|
|
slight increase |
1 |
|
|
normal |
1 |
|
|
decrease |
2 |
|
dislocation of erythropoiesis |
yes |
0 |
|
|
no |
1 |
|
myeloblasts |
< 5% |
0 |
|
|
5 - 20% |
1 |
|
|
21 - 30% |
2 |
|
maturation arrest of granulopoiesis |
(myeloblasts < 5%) AND (no maturation arrest) |
0 |
|
|
(myeloblasts < 5%) AND (maturation arrest present) |
1 |
|
abnormal localization of immature precursors (ALIP) |
no |
0 |
|
|
yes |
1 |
|
atypia of megakaryopoiesis |
no |
0 |
|
|
yes |
1 |
|
myelofibrosis |
no |
0 |
|
|
focal |
1 |
|
|
diffuse |
2 |
|
mast cells |
increased |
0 |
|
|
not increased |
1 |
|
siderin storage |
decreased |
0 |
|
|
normal |
0 |
|
|
increased |
1 |
after Table 6, page 285
histopathologic score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 11 (maturation arrest of granulopoiesis applied only if myeloblasts are < 5%)
|
Histopathologic Score |
Group |
1 Year Survival |
5 Year Survival |
|
0 - 2 |
A |
95% |
43% |
|
3 - 5 |
B |
85% |
20% |
|
> 5 |
C |
60% |
9% |
after Figure 2, page 285
Purpose: To assess prognosis in a patient with primary myelofibrosis using a score based on the histopathologic findings seen in the bone marrow biopsy.
Specialty: Hematology Oncology, Clinical Laboratory
Objective: severity, prognosis, stage
ICD-10: D46,
