Secondary MDS: p53 and CD117 in the Bone Marrow Biopsy May Be Relevant Prognostic Markers.
Roberta SS Tanizawa, Elvira DRP Velloso, Sheila AC Siqueira, Ricardo Rosenfeld, Raymundo Azevedo, Vera Lucia Aldred, Maria Claudia N Zerbini. University of São Paulo School of Medicine, SP, Brazil; UNIFESP School of Medicine, São Paulo, SP, Brazil
Background: In spite of important advances in the area of molecular pathology, bone marrow morphology, evaluated by the smear and core biopsy (BMb) supplemented with immunohistochemistry (IHC) remains an important tool for diagnosis and classification of MDS. Literature data related to BMb findings in secondary MDS are scarce. The aim of this study was to analyze BM immunohistological features in a cohort of patients with secondary MDS from a single center, and correlate with outcome, cytogenetics and IPSS.
Design: Forty-two patients with secondary MDS (23 male, median age 53 yrs, 4-88) were selected from a database of 410 MDS patients. BMb were available from 22 patients including cases of terapy-related MDS and aplastic anemia related-MDS. Biopsies were submitted to H&E, special stains, and IHC for MPO,Glycophorin A, CD61, FVIII, CD20, CD3, CD138, CD34, CD117 and p53. Cellularity,topographical distribution, displastyc megacariocytes (>10%), fibrosis (0-4/Bauermeister score), siderosis (0-3+), lymphoid follicles, Amount and presence of groups (>2 cells) of CD34+ and CD117+ cells, and p53+ cells (1-3+) were assessed. These parameters were correlated with outcome, cytogenetics abnormalities and IPSS.
Results: BMb samples (N=22) revealed overall hypocellularity in 2 (9.1%), fibrosis ≥2 in 13 (62%), ALIPs in 5 (23.8%), lymphoid nodules in 9 (40.9%), CD34+>1% in 17 (77.3%), clusters of CD34+ in 13 (59%), CD117+>1% in 14 (82.3%), clusters of CD117+ cells in 5 (29.4%) and p53+ in 7 (33.3%). CD117, but not CD34 was often present cytoplasm of megacariocytes. OS curves for CD34 did not reach statistical significance. Presence of clusters of CD117+ cells (p=0.02) and p53+ cells were associated with low survival (p=0.05), and p53 was associated to IPSS Intermediate II/High risk (p=0.05).
Conclusions: BMb is an important tool in the evaluation of MDS patients, particularly in cases of secondary MDS, were fibrosis and hipocellularity are more frequent, and BM smears may not be representative (1/3 of cases in this series). BMb has not been performed in half of our patients. IHC is essential including p53 and CD117/CD34 for blasts evaluation, notifying the presence of aggregates of positive cells. P53 has been mentioned in the literature in association with aggressive disease, and larger series of cases are necessary to confirm our observation of “CD117 clusters” as prognostic marker for this condition.
Monday, February 28, 2011 1:00 PM
Poster Session II # 166, Monday Afternoon