犬类骨髓增生异常综合征（MDS）与急性髓性白血病（AML）的标准化骨髓评估、风险变量与生存关系
Standardized bone marrow assessment, risk variables, and survival in dogs with myelodysplastic syndrome and acute myeloid leukemia
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影响因子:1.7
分区:农林科学2区 / 兽医学2区 病理学3区
发表日期:2025 Jan
作者:
Anna M Meredith, Janet Beeler-Marfisi, Olaf Berke, Anthony J Mutsaers, Dorothee Bienzle
DOI:
10.1177/03009858241277982
摘要
骨髓增生异常综合征（MDS）和急性髓性白血病（AML）是异质性血液肿瘤，诊断、鉴别和预后评估存在挑战。人类中细胞遗传学和突变分析具有重要作用，但在犬类中尚无法提供，诊断和分类主要依赖血液学和形态学评估。本研究的目标是应用一种分类方案对髓系肿瘤进行分类，并评估预测变量与临床结局的关系。通过关键词检索实验室数据库，应用序贯排除标准，并由3名评审达成共识，筛选出70例具有血液学结果的髓系肿瘤病例，包括11例细胞学、14例组织学或两者皆有的骨髓标本。根据原始细胞比例和形态，将42例分类为MDS，28例为AML。MDS犬的体重、血红蛋白浓度和血液中的原始细胞明显低于AML犬，而红细胞大小变异性和血小板数量则较高。利用Kaplan-Meier曲线估算两组的中位存活期，MDS组为384天，AML组为6天（P<0.001）。MDS犬的瞬时死亡风险约为AML犬的5分之一。重要的预后预测变量包括体重、白细胞计数、血小板计数和血液中原始细胞比例（P<0.05）。由最适拟合的Cox回归模型得出的危险比（HR）分别为：中性粒细胞增加1.043，血小板减少0.998，血液中原始细胞增加1.061。本研究结果表明，血液学和形态学变量对于预测髓系肿瘤的临床结局具有指导意义。
Abstract
Myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) are heterogeneous neoplasms of hematopoietic stem cells that are challenging to diagnose, differentiate, and prognosticate. Cytogenetic and mutational analyses are useful in humans but unavailable for dogs, where diagnosis and classification still rely largely on hematologic and morphologic assessment. The objectives of this study were to apply a classification scheme to myeloid neoplasms and to assess outcome in relation to predictor variables. Keyword search of a laboratory database, application of sequential exclusion criteria, and consensus from 3 reviewers yielded 70 cases of myeloid neoplasia with hematology results, and cytologic (11), histologic (14), or both (45) types of marrow specimens. Based on blast percentage and morphology, 42 cases were classified as MDS and 28 as AML. Dogs with MDS had significantly lower body weights, hemoglobin concentrations and blood blasts, and higher red blood cell size variability and platelet numbers than dogs with AML. Estimates of median survival using Kaplan-Meier curves for dogs with MDS and AML were 384 and 6 days, respectively (P < .001). The instantaneous risk of death for dogs with MDS was approximately 5× lower than that of dogs with AML. Significant predictor variables of survival were body weight, white blood cell count, platelet count, and percent blood blasts (P < .05). Hazard ratios (HRs) derived from best-fitting Cox regression models were 1.043, 0.998, and 1.061 for increased neutrophils, decreased platelets, and increased blood blasts, respectively. Findings from this study suggest that hematologic and morphologic variables are useful to predict outcomes in myeloid neoplasia.