Hidden myelodysplastic syndrome (MDS): A prospective study to confirm or exclude MDS in patients with anemia of uncertain etiology
Por:
Bastida, JM, Lopez-Godino, O, Vicente-Sanchez, A, Bonanad-Boix, S, Xicoy-Cirici, B, Hernandez-Sanchez, JM, Such, E, Cervera, J, Caballero-Berrocal, JC, Lopez-Cadenas, F, Arnao-Herraiz, M, Rodriguez, I, Llopis-Calatayud, I, Jimenez, MJ, del Canizo-Roldan, MC and Diez-Campelo, M
Publicada:
1 feb 2019
Ahead of Print:
5 oct 2018
Resumen:
Introduction Diagnosis of myelodysplastic syndromes (MDSs) when anemia is the only abnormality can be complicated. The aim of our study was to investigate the primary causes of anemia and/or macrocytosis of uncertain etiology. Methods We conducted a multicenter, prospective study over 4 months in three hematology laboratories. In step 1, we used an automated informatics system to screen 137 453 hemograms for cases of anemia and/or macrocytosis (n = 2702). In step 2, we excluded all patients whose anemia appeared to be due to a known cause. This left 290 patients had anemia of uncertain etiology. In step 3, we conducted further investigations, including a peripheral blood smear, and analysis of iron, vitamin B12, folate, and thyroid hormone levels. Results A differential diagnosis was obtained in 139 patients (48%). The primary causes of anemia were iron deficiency (n = 59) and megaloblastic anemia (n = 39). In total, 25 hematologic disorders were diagnosed, including 14 patients with MDS (56%). The median age of MDS patients was 80 years, 12 had anemia as an isolated cytopenia, and most (n = 10) had lower-risk disease (IPSS-R <= 3.5). SF3B1 mutations were most frequent (n = 6) and correlated with the presence of ring sideroblasts (100%) and associated with better prognosis (P = 0.001). Conclusions Our prospective, four-step approach is an efficient and logical strategy to facilitate the diagnosis of MDS on the basis of unexplained anemia and/or macrocytosis, and may allow the early diagnosis of the most serious causes of anemia. Molecular analysis of genes related to MDS could be a promising diagnostic and prognostic approach.
Filiaciones:
Bastida, JM:
Hosp Univ Salamanca IBSAL, Hematol, Salamanca, Spain
Lopez-Godino, O:
Hosp Univ Salamanca IBSAL, Hematol, Salamanca, Spain
Vicente-Sanchez, A:
Hosp Ribera, Hematol, Valencia, Spain
Bonanad-Boix, S:
Hosp Ribera, Hematol, Valencia, Spain
:
Hosp Badalona Germans Trias & Pujol, Josep Carreras Leukemia Res Inst, Inst Catala Oncol, Badalona, Spain
Hernandez-Sanchez, JM:
Univ Salamanca, CSIC, Ctr Invest Canc, Inst Invest Biomed Salamanca,IBMCC, Salamanca, Spain
Such, E:
Hosp Univ & Politecn La Fe, Lab Citogenet & Biol Mol, Hematol, Valencia, Spain
Cervera, J:
Hosp Univ & Politecn La Fe, Lab Citogenet & Biol Mol, Hematol, Valencia, Spain
Caballero-Berrocal, JC:
Hosp Univ Salamanca IBSAL, Hematol, Salamanca, Spain
Lopez-Cadenas, F:
Hosp Univ Salamanca IBSAL, Hematol, Salamanca, Spain
Arnao-Herraiz, M:
Hosp Ribera, Hematol, Valencia, Spain
Rodriguez, I:
Hosp Badalona Germans Trias & Pujol, Josep Carreras Leukemia Res Inst, Inst Catala Oncol, Badalona, Spain
Llopis-Calatayud, I:
Hosp Ribera, Hematol, Valencia, Spain
:
Hosp Badalona Germans Trias & Pujol, Josep Carreras Leukemia Res Inst, Inst Catala Oncol, Badalona, Spain
del Canizo-Roldan, MC:
Hosp Univ Salamanca IBSAL, Hematol, Salamanca, Spain
Diez-Campelo, M:
Hosp Univ Salamanca IBSAL, Hematol, Salamanca, Spain
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