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Ringed sideroblasts in primary myelodysplasia. Leukemic propensity and prognostic factors
L Vandermolen1, L Rice, M A Rose
1Department of Medicine, Baylor College of Medicine, Houston, TX.
Abstract:
Among 123 patients with ringed sideroblasts on bone marrow aspirates, 85 had acquired ringed sideroblasts with primary myelodysplasia. The patients were placed in categories modified from the French-American-British classification based on percentages of ringed sideroblasts and myeloblasts in the initial bone marrow. Overall, 48% (41/85) of patients with myelodysplasia developed acute leukemia. Primary acquired sideroblastic anemia was the most favorable category with longer survival and 13.8% (4/29) leukemic conversions. Variables correlating with leukemic transformation included male sex, thrombocytopenia, neutropenia, and pseudo-Pelger-Huët neutrophils. Only two variables had independent predictive value by multivariate regression analysis: a high percentage of myeloblasts and a low percentage of ringed sideroblasts. Numerous ringed sideroblasts strongly predicts a more favorable course in myelodysplastic patients.
Insights
Ringed sideroblasts in myelodysplasia indicate a better prognosis. High myeloblast counts and low ringed sideroblast percentages predict acute leukemia development in these patients.
Area of Science:
- Hematology
- Oncology
- Marrow Disorders
Background:
- Ringed sideroblasts are observed in bone marrow aspirates.
- Myelodysplastic syndromes (MDS) are a group of clonal hematopoietic stem cell disorders.
Purpose of the Study:
- To investigate the prognostic significance of ringed sideroblasts in patients with myelodysplasia.
- To identify factors predicting leukemic transformation in myelodysplastic patients.
Main Methods:
- Patients with ringed sideroblasts were categorized using a modified French-American-British classification.
- Multivariate regression analysis was employed to determine independent predictive factors for leukemic transformation.
Main Results:
- Of 123 patients with ringed sideroblasts, 85 had primary myelodysplasia.
- 48% of myelodysplasia patients developed acute leukemia; primary acquired sideroblastic anemia showed a 13.8% leukemic conversion rate.
- High myeloblast percentage and low ringed sideroblast percentage independently predicted leukemic transformation.
Conclusions:
- Numerous ringed sideroblasts are associated with a more favorable prognosis in myelodysplastic patients.
- Predictive factors for leukemic transformation include male sex, thrombocytopenia, neutropenia, and pseudo-Pelger-Huët neutrophils.