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Eosinophilia/Basophilia in MDS
Abstract & Commentary
By William B. Ershler, MD
Synopsis: In a series of patients with MDS, the presence of peripheral blood eosinophilia, basophilia, eosinopenia, and basopenia were each shown to offer prognostic information with regard to overall survival. This information was shown to be of particular additional value for patients with IPSS-Int-2 risk subgroup.
Source: Wimazal F, et al. Eosinophilia and basophilia in a larger color of patients with myelodysplastic syndromes. Cancer. 2010;116:2372-2381.
Myelodysplastic syndromes (MDS) are a heterogeneous group of myeloid disorders characterized by abnormal differentiation and maturation of myeloid cells, reduced bone marrow function, and a genetic instability, with enhanced risk to transform to acute myeloid leukemia.1 Lineage involvement and maturation arrest are considered to have prognostic significance in patients with MDS. However, although the prognostic value of neutropenia, thrombocytopenia, and monocytosis has been documented, little is known about the impact of eosinophils and basophils. Eosinophilia and basophilia are typical features of myeloproliferative disease, most notably chronic myelogenous leukemia, in which basophilia, with or without eosinophilia, is a marker of disease acceleration and adverse outcomes.2,3 Although less commonly observed, basophilia and/or eosinophilia has also been described in MDS.4,5
In the current report, Wimazal and colleagues examined the prognostic significance of eosinophils and basophils among 1,008 patients with de novo MDS. Patients were enrolled from three centers of the Austrian-German MDS Working Group, and were analyzed retrospectively. Blood eosinophils and basophils were quantified by light microscopy, and their impact on survival and leukemia-free survival was calculated using Cox regression.
They found that eosinophilia (eosinophils > 350/lL) and basophilia (basophils > 250/lL) predicted a significantly reduced survival (p < .05) without having a significant impact on leukemia-free survival. In multivariate analysis, eosinophilia and basophilia were identified as lactate dehydrogenase (LDH)-independent prognostic variables, with International Prognostic Scoring System (IPSS)-specific impact. Although elevated LDH was identified as a major prognostic determinant in IPSS low-risk, intermediate-1 risk, and high-risk subgroups, the condition ''eosinophilia and/or basophilia'' was identified as a superior prognostic indicator in the IPSS intermediate-2 risk subgroup.
Thus, in a relatively larger series of de novo MDS patients, the authors were able to confirm the prognostic importance of both eosinophilia and basophilia, and demonstrated its particular value for patients with INT-2 risk (per IPSS). Although useful in predicting overall survival, eosinophilia/basophilia, in this series, did not predict progression to AML. This is in contrast to data presented by Matsushima and colleagues.4
Curiously, there have also been reports that low basophil counts in patients with MDS predict adverse outcomes, including progression to AML.5,6 In analysis of the current series, it was discovered that the absolute absence of either peripheral blood basophils or eosinophils was also an independent negative prognostic factor in terms of overall survival.
An explanation for the observed reduced survival among patients with eosinophilia and/or basophilia or eosinopenia or basopenia remains unknown. Although cytogenetic abnormalities were more common in this series in patients with basophilia and/or eosinophilia, no consistent abnormality was reported, and it remains possible that these findings reflect dysregulated marrow function, for which a unifying pathway is not currently apparent.
For clinicians, the findings indicate that abnormal eosinophil or basophil counts (either high or low) are of prognostic value and may ultimately prove useful in determining treatment approach.
1. Hofmann WK, Koeffler HP. Myelodysplastic syndrome. Annu Rev Med. 2005;56:1-16.
2. Denburg JA, Browman G. Prognostic implications of basophil differentiation in chronic myeloid leukemia. Am J Hematol. 1988;27:110-114.
3. Steegmann JL, et al. Stage, percentage of basophils at diagnosis, hematologic response within six months, cytogenetic response in the first year: The main prognostic variables affecting outcome in patients with chronic myeloid leukemia in chronic phase treated with interferon-alpha. Results of the CML89 trial of the Spanish Collaborative Group on interferon-alpha2a and CML. Haematologica. 1999;84:978-987.
4. Matsushima T, et al. Prevalence and clinical characteristics of myelodysplastic syndrome with bone marrow eosinophilia or basophilia. Blood. 2003;101:3386-3390.
5. FurederSchernthaner GH, Ghannadan M, et al. Quantitative, phenotypic, and functional evaluation of basophils in myelodysplastic syndromes. Eur J Clin Invest. 2001;31:894-901.
6. Shibata K, et al. Importance of basophilia in haematopoietic disorders. Haematologia (Budap). 1998;29:241-253.