Re: Digest for hematologyindia@googlegroups.com - 2 updates in 1 topic

5 views
Skip to first unread message

DEEPAK KUMAR MISHRA

unread,
Sep 19, 2016, 7:45:46 PM9/19/16
to hematol...@googlegroups.com

Good discussion indeed. Such morphologic exercises will keep happening even till you have the next one in 2024 or so.

I have personally discussed this with Mario Cazzola, who is one the authors in the Myeloid Group. The way you have been looking at AML-M6 ( pure erythroid / erythroid myeloid ) has changed conceptually. Now no role of NEC and TNC is here to stay. This will reduce inter-observer variability. Mario said many of the MDS's before were labelled as AML-M6 transitioning from MDS in the previous classification.

It is believed the IPSS / WPSS should have another revision. The next International MDS Symposium at Valencia, Spain in May,2017 will discuss this. 

Warm regards.

Dr. Deepak K Mishra

Tata Medical Centre, Kolkata.




From: hematol...@googlegroups.com <hematol...@googlegroups.com>
Sent: Monday, September 19, 2016 7:00 PM
To: Digest recipients
Subject: Digest for hematol...@googlegroups.com - 2 updates in 1 topic
 
Prashant Sharma <prash...@gmail.com>: Sep 18 05:23PM -0700

In what would be a major change from the existing as well as the proposed
WHO recommendations, these authors (backed by what they claim is the
"largest series of patients with MDS with erythroid hyperplasia") report
that calculating the percentage of BM blasts from non-erythroid cells to
assign the final category of MDS improves prognostic assessment. It's
currently calculated from the total nucleated cells differential (by those
who follow the WHO anyway). This better prognostication was true for both
erythroid-rich and non-erythroid-rich MDS.
 
Are we going to switch to NEC blast percentages very soon?
 
You can read the full article for free
here: http://jco.ascopubs.org/content/34/27/3284.long
 
Prashant Sharma
Sanjeev Gupta <drskg...@gmail.com>: Sep 19 10:52AM +0530

Thanks for sharing the article Prashant. I wish to make two points
regarding this study:
 
1. .The message I get from JCO study is to give more weight to the blast %
in the prognostication of MDS and probably, this can be done by modifying
the prognostic scoring systems (maybe more blast categories & with higher
scores) rather than again changing the consensus diagnostic criteria. The
current WHO-2016 recommendation about using total marrow cells rather than
non-erythroid cells aims at bringing uniformity and more reproducibility of
blast % and possibly a step in the right direction
 
2. The WHO-2016 recommendation of abolishing the Erythroleukemia category
and categorizing the cases with* >*50% erythroid cells with* >*20% blasts
out of NEC (but <20% blasts of TNC) as MDS has also been backed by studies
showing the biological behaviour & genetics of this category similar to MDS
rather than AML. The JCO study (based on the 2008 classification) has not
included such cases in their study. It would be interesting to check the
clinical outcome of the upgraded cases of MDS (based on blast % using NEC)
compared to that of Erythroleukemia cases downgraded to MDS (based on blast
% using TNC as per 2016 classification).
 
Regards,
Sanjeev
--
Dr Sanjeev Kr Gupta,
MD, DNB, DM (Hematopathology)
Assistant Professor, Lab Oncology,
Room No. 424, Dr BRA IRCH,
All India Institute of Medical Sciences (AIIMS),
New Delhi-110029.
 
On Mon, Sep 19, 2016 at 5:53 AM, Prashant Sharma <prash...@gmail.com>
wrote:
 
You received this digest because you're subscribed to updates for this group. You can change your settings on the group membership page.
To unsubscribe from this group and stop receiving emails from it send an email to hematologyind...@googlegroups.com.
Reply all
Reply to author
Forward
0 new messages