Third International Symposium on Myelodysplastic Syndromes 39

IPartier V.. 2van Melle G.. 3Beris ph., ‘&hmidt P.M., %obler A., *Hailer E., ‘Jotterand Bellomo M. ‘Division de OtnCrique Medic-ale et 4Divisioo d’tltmatologie. CHUV. Lausanne. ZInstitul de M&de&e Sociale et Pr&entive. Universitt. Lausanoe. 31)lvision d’H6ma~ologie. HCUG, Ccr~&ve. ~matologischts Zmtrallabor. Inselspital. Bern, Switzerland

The predictive potential of 6 selected factors was assessed in 72 patients with univarlate and multivariate logistic

ass&e&d w#h these 2 factors means that they have about the same weight. Consequrntfy the model was simpfii by counting the number of facBDrs (0.1 or 2) present in eadr pat&M, thus generating a scoring system called the LauaantraBoumsmouth score (LB-score). The LB-score combines the well recognitsd and easy to usa Bournamouth score (B-score) with the chromosome d&act 23 amstftuting an additional indicator of patianf outcome. The of death within 18 months calculated from the m4def is 1.7-24.6) for patients with an LB-score of f 1 and 96.6% (64.Sss.4) for en L&score interesting features. The LB- score may e B-score, as it is able to recognize 2 pr&nostic

P s in the intermediate risk category of patients with

B-scores of 2 or 3. It as also the abilii to identii 2 distinct orounostic subdasses aming RAE@ and sibfy CMML pat&r&. In addition to its din&l usefulness+n da&ion m slltr ng regarding thsrapMical strategies, the Ls score may bring new in@ghts into the understanding of evolution patterns in MOS. We used the combination of the B-score and the chromosome complexity to define 4 &asses which may be considered as 4 possible states of my&dysplasia and which describe 2 distinct evolutional pathways.

Prognostic Value of Histological Parameters and CD34 Reactivity in the Bone Marrow Biopsies of MDS Patients

G. LAMBERTENGHI DELILIERS, C. ANNALORO. A. ORIANI, E. POZZOLI, A. CORTELEZZI, L. VENEGONI Centro Trapianti di Midollo, University of Milan, Italy

Diagnostic hone marrow hiopsies (BMB) were reviewed and CD34 immunostaining was performed in a series of 72 pts (male 52, female 20, median age 64 years, range 16-81) The cytological diagnoses were RA in 10, AISA in 12. RAEB in 33, RAEB-t in 14 and CMML in 3 cases. The prognostic values of the hematological, cytological, histological and immunohistochemical parameters were looked for both univariately and multivariately. As of 31-3-94, 46 pts. had died (29 after leukemic transformation) and 26 pts. were still alive (1 after leukemic transf~~rmation). At univariate analysis, the pattern of hlastic infiltration at BMB (G. Lamhertenghi Deliliers, Ann. Hematol. 66: 85-91, 1993) and CD34 positivity (in terms of percentage and CD34 positive aggregates) were the only predictors of leukemic transformation and survival. FAB classification significantly correlated with transformation hut not survival; nevertheless, a statistically signilicant difference in survival was ohserved when subtypes with an excess of hlasts were compared with those without. Discriminant functions were calculated in order to predict both transformation and short survival (12 months or less). In the former, the limction (predictive level 73.24%) took into account the percentage of hone marrow blasts and CD34 positivity, hone marrow cellularily and sex; in the latter (predictive level 70.83). the function took into account the pattern of hlastic infiltration, tihrosis, the percentage of Cl134 positivity, WBC al diagnosis and the Bournemouth score. The present rcsulis indicate that lcukcmic Iransformation is not the only event affecting survival in MDS, since variables predicting the former are incapable of also predicting the tatter. In conclusion, histological findings and CD34 immunostaining applied to BMB offer lhe possihility of investigating reliable prognostic factors in addilion to those represented by common hematological und cytological parameters. The present data allow the identification of a small group of patients with a very short life-expectancy (due to transformation or hone marrow hilure) and make it possible to design an appropriate therapeutic strategy.

Prognostic importance of type II blasts in refractory anemia with excess of blasts (RAEB). A report on 91 cases.

A.P. GUERCI, L. FELMANN’, JC. HUMBERT’), O.CUERCl. Service de M6dccinc A. ‘SIMES. HBpital Marin. “Service de Cytologie. CTS. All&z du Morvan. 54511Vandoeuvre-lb-Nancy. FRANCE The myelodysplastic syndromes (MDS) are a hctcrogcncous group of primary haematological disorders. Prognosis in MDS is extremely variable. The FAB classification has a strong prognostic value. The biological and clinical outcome differences among the FAB subtypes have trigged the search for prognostics factors in each FAB subtype. In this study, we analyzed the prognostic value of haematological features in peripheral blood and bone marrow smears in patients (pts) with de nova RAEB. From Jan. 1982 to Dec. 1992, 91 pts 146 male, 45 female) (mean age: 67 yrs) were studied. At the time of analysis, 38 pts were alive. Progression to acute lcukacmia was observed in 14 pts (15.4You). In univariate analysis: male sex (P <.OOl), high bone marrow type 1 (I’ <.03), type 11 (P =.0006) and total blast ccl1 pcrcentagcs (P =.(X)06) (%) and low haemoglobin (Hb) level (P =.04) wcrc associated with shorter survival. By multiple regression analysis (BMDP software), prognostic factors for survival were: type II (chi-square (CS) = 9.0, P =.0027) and type 1 (C’S: 8.6,P =0.003) blast cell %, sex (CS: 6.5, P =.()I), Hb lcvcl (CS: 5.5, P =.02) and platelet count KS: 2.8, P =.09). A soring index could bc designed based on sex (1 point for male, 0 for female), type I blast cells (1 point for 2 3’%, 0 for < 3%), type II blast cells (1 point for 5 8%. 0 for < 8%), Hb (1 point for 6 lOg/dl, 0 for z lOg/dl) and platelets (0 point for > 180.10*9/l, 1 for 101 to 179.10*9/l, 2 for < 100. 10’9/1). The total score was able to separate pts m 3 groups with low (score 0 to 3), intermediate (score 4 to 6) and high risk (score 7 to 10) which included 25%, 57% and 18% of the pts and had a median survival of 312, 143 and 40 days rcspcctivcly (CS = 35.6, P <.CK)Ol). Conclusion: Based on routine parameters, a scoring index may bc dcvclopcd which could allow to better define the therapeutic approach in pts with RAEB.

Compdson of differaM tcodRg s- f- risk sndysk in MDS C. AUL, U. GERMING, V. RUNDE, N. GATTERMAN Department of Internal Medicine, Hemetologv and Oncology Division, Heinrich-Heine-University, Diisseldorf, Cfermany The MDS Risk An&is Workshop pla~ to compare V&CIUS scoring svs@ms for their pre- dictive value in MDS. As part of this imerrtat~l effort, we tetrosowtivelv an&red the dafa of 735 untrested patients (369 men, 346 women:median a@ 74 &, rangs 1 B-96 yrsl wifh primary MDS, diagnosed (It the University of Diuaddnt between 1969 end 1994. In addiiion fo the FAB cl~ss&fication. 6mz ICMO, k&ml score. and International Workshop Risk Score we used 411 local scoring !ws@m I- swm L&m m-2, 19921 for risk evalwtion. End points of an&v& wem survival and dweloument of AML. Due to Ia- cvto@n&c dat. at dirprm*;we Eo(IM - rt* ktic vakm of the Morel scora and lntemationaf Workshop ftisk Score in only to9 pstfarts. Ths esfimatsd survival for the entire series was 23 months, with 121 petients t16%1 proprearing lo AML. Results obtained with the respective scores 818 shown below in fsbulated form.

Score Risk Patients Percentile of survival lmol P Progression x2 P Group IllI 75% 50% 25% fo AML (nl

FAB RA RARS RAEB RABB/T CMML

Sam A B C

Dassel- A dorf B

C

Morel A B C

Intern. A Risk B

179 16 37 78 ~10’ 23 64 <IO’ 192 18 50 loo II 173 5 10 26 42 80 2 4 9 33

III 6 16 45 12

310 26 53 103 <IO 37 s5 <IO’ 290 5 13 33 41 121 2 5 14 42

<IO 6 32 <IO’ 52 52

117 47 76 II8 371 II 29 65 182 2 6 13

44 57 108 141 48 8 31 67 II 3 6 16

62 43 67 141 29 ti 23 83

< 10’ 6 22 <IO” 11

<III’ 9 I4 <IO’ 6