Análise morfológica e citogenética de medula óssea em pacientes com síndrome mielodisplásica primária

Abstract

The primary myelodysplastic syndrome (MDS) comprises a heterogeneous group of clonal bone marrow disorders characterized by varying degrees of pancytopenia and morphological abnormalities of hematopoietic cells, and an increased risk of transformation into acute myeloid leukemia. The morphology and the cytogenetic of bone marrow play a key role in the diagnosis and the prognosis. Chromosomal abnormalities are found in 30-50% of cases. Due to the importance of analyzing these factors for therapeutic choice, it becomes necessary to define the morphological and the cytogenetic changes which could contribute to the prognosis.The aim of this study was to analyze the morphological and cytogenetic features of bone marrow and their correlations with FAB and WHO clasification and IPSS. We studied 32 patients with primary MDS between 2000 - 2009. The clinical data was recovered from medical records. Morphological characteristics were analyzed through a review of bone marrow biopsies and mielogram slides. Cytogenetic analysis was performed by GTG banding from bone marrow cells. The patients were classified according to FAB in initial stages: RA (22 patients) and RARS (1 patient) and nine in advanced stages - RAEB. Chromosomal abnormalities were detected in 16 patients (50%). The most frequent abnormalities were: del(11)(q23) and del(17p). Patients with advanced disease, six (66%) had significant increased M:E ratio (p=0.003) and seven patients (77%) had increased architectural changes (p<0.001). Patients classified as intermediary 2 and high risk according IPSS had important architectural loss (p<0.001), presence of micromegakaryocyte was considered significant higher (p=0.017) and six patients (85%) underwent leukemia transformation (p=0.006). ALIP was significant higher in the patients with a worse prognosis (p=0.021) and advanced stage of disease (p=0.001). Our results showed potential implications for diagnosis and prognosis of MDS. The morphological findings in this study were associated with FAB and WHO groups and prognostic risk (IPSS).