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Prepublished online as a Blood First Edition Paper on July 18, 2002; DOI 10.1182/blood-2002-01-0222.
Submitted January 28, 2002
Accepted July 8, 2002
Clinical significance of phenotypic features of blasts in patients with myelodysplastic syndromes
Kiyoyuki Ogata*, Kyoko Nakamura, Norio Yokose, Hideto Tamura, Mikiko Tachibana, Osamu Taniguchi, Rika Iwakiri, Tatsuyuki Hayashi, Hisashi Sakamaki, Yoshiro Murai, Kaoru Tohyama, Shigeru Tomoyasu, Yasunobu Nonaka, Mayumi Mori, Kazuo Dan, and Yataro Yoshida
Division of Hematology, Nippon Medical School, Tokyo, Japan
Hematonosis Cell Analysis Center, Otsuka Assay Laboratories, Tokyo, Japan
Division of Hematology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
Division of Hematology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
Division of Hematology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
Division of Hematology, Tokyo Metropolitan Tama Geriatric Hospital, Tokyo, Japan
Division of Hematology, Kyoto University, Kyoto, Japan
Division of Hematology, Showa University, Tokyo, Japan
Division of Hematology, Takeda Hospital, Kyoto, Japan
* Corresponding author; email: ogata{at}nms.ac.jp.
Knowledge of the blast phenotype in myelodysplastic syndromes (MDS) would be valuable, as in other malignancies, but remains sparse. This is mainly because MDS blasts are a minor population in clinical samples, making analysis difficult. Thus, for this blast phenotype study, we prepared blast-rich specimens (using a new density-centrifugation reagent for harvesting blasts) from blood and marrow samples of 95 patients with various MDS subtypes and 21 patients with acute leukemia transformed from MDS (AL-MDS). Flow cytometry revealed that a high proportion of the enriched blast cells (EBCs) from almost all cases showed an immunophenotype of committed myeloid precursors (CD34+CD38+HLA-DR+CD13+CD33+), regardless of the disease subtype. The cytochemical reaction for myeloperoxidase was negative in 58% of the cases. Thus, the EBC phenotype is more immature in MDS than in de novo acute myeloid leukemia. MDS EBCs often coexpressed stem-cell antigens and late-stage myeloid antigens asynchronously, but rarely expressed T- and B-lymphoid cell-specific antigens. Markers for myeloid-cell maturation (CD10 and CD15) were more prevalent on EBCs from low-risk MDS (refractory anemia [RA] and RA with ringed sideroblasts), while markers for myeloid-cell immaturity (CD7 and CD117) were more prevalent on EBCs from high-risk MDS (chronic myelomonocytic leukemia, RA with excess blasts [RAEB] and RAEB in transformation) and AL-MDS. A shift to a more immature phenotype of EBCs, accompanying disease progression, was also documented by sequential phenotyping of the same patients. Further, CD7-positivity of EBCs was an independent variable for a poor prognosis in MDS. These data represent new, valuable information regarding MDS.
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