In patients with ALL, survival was associated with cytogenetic status, performance status, WBC count, absolute lymphocyte count, age, platelet count, and B2M level Table 3. The presence of a higher percentage of blasts in PB than in BM was not associated with survival, despite the fact that the both the PB and the BM blast percentage, when considered individually, were Table 3 ; Figure 3.
Survival rates did not differ significantly between patients with a higher percentage of blasts in PB than in BM and those with a higher percentage of blasts in BM than in PB. In a multivariate model incorporating all factors found to be significant in univariate analysis, cytogenetic status and the presence of a higher blast percentage in PB than in BM were retained as independent prognostic indicators in MDS Table 4.
Furthermore, multivariate analysis incorporating IPSS classification and having higher blasts in PB than BM showed that both were independent of each other in predicting survival.
Importantly, this association was independent of other key prognostics factors, including cytogenetic status. The exact biological explanation for the relative increase in PB blast percentage in some patients with MDS or acute leukemia is not known. Recent studies showed that the presence of an increased number of myeloid colony-forming units in the PB of patients with MDS is associated with decreased survival and a tendency toward transformation into AML.
Little is known about the exact factors that control the mobilization of BM blasts into PB, although adhesion molecules, chemokines, and angiogenic factors are believed to play a role. Most likely, these and other factors interact with each other in a complex fashion to determine which blasts will circulate and which will stay in BM. The independent prognostic value of this phenomenon highlights the importance of exploring the causes behind it, and suggests that investigating its underlying causes may help in devising therapeutic strategies.
It is possible that blasts in patients with relatively high PB blast percentages are more capable of invading extramedullary tissues, which may protect them from chemotherapy. Our study raises an important question related to the relevance of considering the PB and BM blast percentage differently in the classification of MDS. It is possible that the higher percentage of PB blasts reflects a greater tumor mass and is not necessarily related to homing.
However, a significant number of AML patients have massive infiltration of BM by blasts, but lack circulating blasts. Investigation of the characteristics of PB cells in relation to BM blasts may not only allow us to better understand the biology of circulating blasts, but may also help in developing therapeutic strategies.
Proposals for the classification of acute leukaemias. Br J Haematol ; 33 : — Proposed revised criteria for the classification of acute myeloid leukemia. Ann Intern Med ; : — Proposals for the classification of the myelodysplastic syndromes. Br J Haematol ; 51 : — Myelodysplastic syndromes: introduction. Google Scholar. Slow disappearance of peripheral blood blasts is an adverse prognostic factor in childhood T cell acute lymphoblastic leukemia: a Pediatric Oncology Group study.
Leukemia ; 14 : — Increased peripheral stem cell pool in MDS: an indicator of disease progression? Leuk Res ; 25 : — Circulating myeloid colony-forming cells predict survival in myelodysplastic syndromes. Ann Hematol ; 82 : — Significance of angiogenin plasma concentrations in patients with acute myeloid leukaemia and advanced myelodysplastic syndrome. Br J Haematol ; : — Soluble hepatocyte growth factor sHGF and vascular endothelial growth factor sVEGF in adult acute myeloid leukemia: relationship to disease characteristics.
Hematology ; 7 : — Expression of focal adhesion kinase in acute myeloid leukemia is associated with enhanced blast migration, increased cellularity, and poor prognosis.
Cancer Res ; 64 : — Differential adhesiveness between blood and marrow leukemic cells having similar pattern of VLA adhesion molecule expression.
Leuk Res ; 22 : — View the booklet Acute Myeloid Leukemia in Adults for a full listing of chromosome and gene abnormalities.
This checklist will help ensure that you receive the best treatment for your unique situation: Click Here. The exact diagnosis helps the doctor to Estimate how the disease will progress Determine the appropriate treatment Diagnosing acute myeloid leukemia AML and your AML subtype usually involves a series of tests.
Blood Tests Blood samples are generally taken from a vein in your arm. Your blood is sent to a lab for the following tests: A complete blood count CBC with differential counts the number of red cells, white cells and platelets in the blood.
The CBC should include a differential, which measures the numbers of the different types of white blood cells in the sample. People with AML often have a high number of white blood cells, but most of these are leukemia blast cells that do not protect against infection. They may also have a low number of red blood cells and platelets.
A peripheral blood smear examines the number, shape and size of the red blood cells, white blood cells and platelets to determine whether there are leukemia blast cells in the blood. In patients with AML, many of the white blood cells in the sample may be immature or leukemia blast cells which are not normally found in the circulating blood.
Bone Marrow Tests Samples of marrow cells are obtained by bone marrow aspiration and biopsy. Bone marrow testing involves two steps usually performed at the same time in a doctor's office or a hospital A bone marrow aspiration to remove a liquid marrow sample A bone marrow biopsy to remove a small amount of bone filled with marrow Bone marrow samples are usually taken from the hip bone.
Cell Assessment At the laboratory, a hematopathologist examines the blood and bone marrow samples. Immunophenotyping Flow Cytometry This test is used to diagnose leukemia and lymphoma by comparing cancer cells to normal cells in either a bone marrow or blood sample.
Molecular Tests These are tests used to examine the chromosomes and genes in a patient's leukemia cells. Although chemotherapy, the use of drugs to destroy cancer cells throughout the body, is often an important treatment option for people with cancer, it can also increase the odds of developing a myelodysplastic syndrome.
Some chemotherapy drugs carry a higher risk than others. Prior radiation therapy for cancer further adds to this risk. Some inherited conditions increase the risk of developing myelodysplastic syndromes. These include trisomy 21, which is more commonly known as Down syndrome. Myelodysplastic syndrome is also linked to paroxysmal nocturnal hemoglobinuria, in which red blood cells break down before they are supposed to, and Fanconi anemia, a disorder that affects the bone marrow.
The risk of developing a myelodysplastic syndrome increases with age. The majority of people diagnosed with the condition are older than age If doctors suspect you have a myelodysplastic syndrome, they may conduct blood tests and a bone marrow aspiration and biopsy.
They also perform tests to determine whether the condition has a low, intermediate, or high risk of progressing to AML, a form of blood cancer. Blood is drawn to check the levels, shape, and size of white cells, red cells, and platelets.
The levels of one or more blood cell types may be low in people who have a myelodysplastic disorder. When examined under a microscope by one of our hematopathologists—specialists who study diseases of the blood—blood cells may appear misshapen or have other abnormalities. Blast cells, which are normally only present in the bone marrow, may be circulating in the bloodstream in people with myelodysplastic syndromes.
If blood test results indicate a myelodysplastic disorder may be present, doctors conduct a bone marrow aspiration and biopsy to diagnose the condition. NYU Langone doctors diagnose myelodysplastic syndromes using a bone marrow aspiration and biopsy. During this procedure, in which a local anesthetic is used, your doctor uses two small needles to remove bone marrow fluid and tissue from the pelvic bone in the lower back.
You can go home the same day. The cells are then sent to a laboratory where a hematopathologist uses sophisticated genetic testing to determine whether there are mutations in certain genes or breaks in the chromosomes. This can lead to problems with stem cell maturation, decreased production of different blood cells, and the development of increased blasts in the marrow.
The hematopathologist also measures the percentage of bone marrow blasts.
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