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Dysplastic peripheral blood polymorphs link acute myeloblastic leukaemia in elderly to the myelodysplastic syndromes
Abstract:
We studied dysplastic features in peripheral blood polymorphs from 80 patients with acute leukaemia. Thirty-seven patients with de novo acute myeloblastic leukaemia (AML) were compared to 26 patients with AML that had developed after a myelodysplastic phase (MDS-AML), and 17 cases of acute lymphoblastic leukaemia (ALL). Cytoplasmic hypogranulation in neutrophils, measured as a score value (G-score; normal range: 255-300), and the percentage of pelgeroid polymorphs (ppp; normal range: 0.5%) were studied retrospectively by reviewing the diagnostic peripheral blood smears. The mean G-score was decreased in MDS-AML (178 +/- 67.9), and in de novo AML (212 +/- 65.1), but not in ALL (275 +/- 24.3). When de novo AML patients were divided by age, the elderly (greater than 60 yr) had significantly (p = 0.0001) lower mean G-score than the younger (less than 45 yr) ones; 156 +/- 64.8 v 243 +/- 41.4. This age-related difference became accentuated when only patients with extreme hypogranulation (G-score less than 150) were studied. Elderly de novo AML patients also had significantly (p = 0.0057) higher mean ppp. By studying the degree of polymorph dysplasia in the peripheral blood, it seems possible to identify a subset of dysplastic elderly AML patients, who might have passed a (preleukaemic) MDS phase unnoticed.
Insights
Peripheral blood polymorph dysplasia, including hypogranulation and pelgeroid features, can help identify elderly acute myeloid leukemia (AML) patients who may have had an undiagnosed myelodysplastic syndrome (MDS) phase.
Area of Science:
- Hematology
- Oncology
- Cellular Morphology
Background:
- Acute myeloid leukemia (AML) can arise de novo or after a myelodysplastic syndrome (MDS) phase.
- Peripheral blood polymorph dysplastic features are potential indicators of underlying hematological disorders.
- Assessing these features may aid in classifying AML subtypes and identifying pre-leukemic phases.
Purpose of the Study:
- To investigate dysplastic features in peripheral blood polymorphs in patients with acute leukemia.
- To compare these features between de novo AML, MDS-AML, and acute lymphoblastic leukemia (ALL).
- To explore potential age-related differences in polymorph dysplasia within AML subtypes.
Main Methods:
- Retrospective review of peripheral blood smears from 80 acute leukemia patients.
- Quantification of cytoplasmic hypogranulation in neutrophils using a G-score.
- Measurement of the percentage of pelgeroid polymorphs (ppp).
- Comparison of G-scores and ppp across different leukemia groups and age demographics.
Main Results:
- MDS-AML and de novo AML patients showed significantly lower mean G-scores compared to ALL patients.
- Elderly de novo AML patients (over 60 years) exhibited significantly lower mean G-scores than younger patients.
- Elderly de novo AML patients also presented with a significantly higher mean ppp.
- Extreme hypogranulation (G-score < 150) was more pronounced in elderly de novo AML patients.
Conclusions:
- Peripheral blood polymorph dysplasia, characterized by hypogranulation and pelgeroid changes, is a relevant indicator in AML.
- Elderly AML patients demonstrate distinct dysplastic features, suggesting a potential link to an unrecognized MDS phase.
- Assessing polymorph dysplasia may help identify a subset of elderly AML patients with a preceding MDS phase.