Page 94 - Haematologica Atlas of Hematologic Cytology

The problems in in the the morphological diagnosis of of MDS are mainly due to the the non-specificity of of dysplastic chan- ges Morphological alterations may be observed even in in healthy BM and in in patients with non-clonal disorders moreover poor quality of of BM specimens and various artifacts may lead to misinterpretation The lack of of clinical information and of of available cytogenetic results can also hinder a a a a a a a a a a a a correct diagnosis To allow the application of of well-codified reproducible criteria for a a a a a a a more objective morphological evaluation and thus a a a a a a a correct implemen- tation of the WHO classification we developed a a a a a a a a morphological morphological score for defining minimal morphological morphological criteria for MDS (Della Porta et et al al 2015 2015 Invernizzi et et al al 2015) This score is is highly specific and and sensitive and and has been independently validated It improves the the objectivity and and reproducibility of microscopic analysis and and might the- refore be very useful in the work-up of patients with suspected MDS In doubtful cases an an observation period of six months and repeated BM examination is recommended prior to to making a a a a a a a a diagnosis of of MDS For patients with persistent cytopenia (at least 6 months) in in the absence of of mor- phological or or cytogenetic evidence sufficient for a a a a a definitive diagnosis of of MDS the term “idiopathic cytopenia of of undetermined significance (ICUS)” should be used Recently the new molecular techniques including gene expression profiling and analysis of of point mutations have allowed clonal abnormalities of considerable diagnostic and prognostic meaning to be detected even in in patients with normal karyotype However only the use of a a a a a a a single mutation (SF3B1) has been incorporated into the definition of an an MDS entity Many myeloid-associated somatic mutations have been identified even in in normal healthy elderly individuals and it may therefore be difficult to determine whether an an identified mutation indica- tes MDS MDS or is is is an incidental finding Given this new MDS-related early entities such as “clonal hematopoiesis of indetermined potential (CHIP)” and “clonal cytopenia of undetermined significance (CCUS)” have been defined and these should be carefully monitored for any unpredictable disease course References
Arber DA Orazi A A A Hasser ian R et al al The 2016 2016 revision to the World Health Organiza on on on classi ca on on on of myeloid neopla- sms and acute leukemia Blood 2016 2016 127(20):2391-2405 Della Porta MG Travaglino E E Boveri E E et al al al al Minimal morphological criteria for for de ning bone marrow dysplasia: a a a a a a a a a a a a a a a a a a a basis for for clinical implementa on on on of of WHO classi ca ca ca on on on of of myelodysplas c c c c c c c syndromes
Leukemia 2015 29(1):66-75 Goasguen JE Benne JM Bain BJ et al al Proposal for re ning the de ni ni on of dysgranulopoiesis in in in acute myeloid leukemia and myelodysplas c syndromes
Leuk Res 2014 38(4):447-453 Goasguen JE Benne JM Bain BJ et al al al uality control ini a a a a a a a a a a a a a ve on on on the the the evalua on on on of of the the the dysmegakaryopoiesis in in in in myeloid neoplasms: Di cul es
es
es
in in in the the assessment of dysplasia Leuk Res 2016 45:75-81 Goasguen JE Benne JM Bain BJ et al Dyserythropoiesis in in the the the diagnosis of the the the myelodysplas c syndromes
and other myeloid neoplasms: problem areas Br J J J J Haematol 2018 182(4):526-533 Hasser ian RP Orazi A A Brunning RD et et al al Myelodysplas c c c syndromes: Overview In: Swerdlow SH Campo E E Harris NL et et al al (Eds) WHO Classi ca on on on of of Tumours of of Hematopoie c c c and Lymphoid Tissues (Revised 4th edi on) IARC: Lyon 2017 p 98-106 Invernizzi R uaglia F Porta MG Importance of of classical morphology in the diagnosis of of myelodysplas c c c c c syndrome Me- diterr J Hematol Infect Dis 2015 2015 7(1):e2015035 Malcova L L L Hellstr m-Lindberg E E Bowen D D et et al al Diagnosis and treatment of primary myelodysplas c c c syndromes
in in adul- ts: recommenda ons from the European LeukemiaNet Blood 2013 122(17):2943-2964 Mu i i i i i i GJ Benne JM Goasguen J J J et al al al Diagnosis and and classi ca on on on on on of of myelodysplas myelodysplas c c c c c syndrome: Interna onal Working Group on on on on on on Morphology of of of myelodysplas myelodysplas c c c c c c syndrome syndrome (IWGM-MDS) consensus proposals for the de de ni on on on on on on and and and enumera- on on on of of myeloblasts and ring sideroblasts Haematologica 2008 93(11):1712-1717 alent P P P Orazi A Steensma DP et et al al al al Proposed minimal diagnos c c c c c criteria for myelodysplas c c c c c syndromes
(MDS) and po- ten al al al al pre-MDS condi ons Oncotarget 2017 8(43):73483-73500 81