• myelodysplastic syndromes;
  • refractory anaemia;
  • macrocytosis;
  • survival;
  • myelodysplasia

We read with interest the recent paper by Tennant et al (2002) comparing the prognoses of myelodysplastic syndrome (MDS) patients. They reported that the mean corpuscular volume (MCV) and the marrow myeloblast number were used to define four groups with prognostic significance. A low-risk group was characterized by macrocytosis associated with < 5% myeloblasts, while a high-risk group was related to blast counts ≥ 5% and an MCV < 100 fl. We were particularly interested in their analysis of patients with < 5% myeloblasts. Their analysis of survival curves revealed a significant difference; in MDS patients with < 5% myeloblasts, the patients with macrocytosis had higher survival probabilities than those without macrocytosis. We wish to report our experience of MDS patients that did not demonstrate an increase in blasts.

Patients that had previously received a transfusion and, therefore, had an unknown true MCV value at diagnosis were excluded from this study. Fifty-eight consecutive MDS patients with < 5% myeloblasts were analysed between January 1983 and December 2000. The median age of patients with < 5% myeloblasts was 55 years (range 16–88 years). The mean MCV value of these patients was 108·0 fl (range 89·3–127·9 fl). The frequency of our patients with an MCV < 100 fl (22·4%) was lower than that of the frequency (54·0%) reported by Tennant et al (2002). Therefore, we divided the MCV values by three separate thresholds of 100, 105 and 110 fl, and examined the survival of each subsequent pair of groups.

The Kaplan–Meier method was used to estimate the probability of overall survival. Survival was measured from the date of diagnosis at the Saitama Medical School Hospital until either death or the last patient contact, as of January 2001. The analysis of survival curves was performed using the log-rank test. In the MDS patient group with < 5% myeloblasts, patients with an MCV ≥ 100 fl had a median survival of 78 months (range 2–216 months), while patients with an MCV < 100 fl had a median survival of 38 months (range 3–140 months). This difference was not significant (P = 0·4281; Fig 1A), and significant differences were not demonstrated even when an MCV value threshold of either 105 or 110 fl was used (Fig 1B and C).


Figure 1.  The cumulative survival probability of myelodysplastic syndrome patients with < 5% myeloblasts. (A) MCV ≥ 100 fl (n = 45, median age 56 years, range 16–88 years) versus MCV < 100 fl (n = 13, median age 54 years, range 34–81 years): P = 0·4281. (B) MCV ≥ 105 fl (n = 35, median age 56 years, range 16–86 years) versus MCV < 105 fl (n = 23, median age 54 years, range 22–88 years): P = 0·7875. (C) MCV ≥ 110 fl (n = 33, median age 62 years, range 16–86 years) versus MCV < 110 fl (n = 25, median age 57 years, range 22–88 years): P = 0·8905.

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Both the distribution of patient MCV values and the median age of the patients (55 compared with 70 years respectively) in our study differed to those of the study by Tennant et al (2002). Although there were some differences in the characteristics of patients between the two studies, our study did not support the result that macrocytosis was a favourable prognostic factor for MDS patients with < 5% myeloblasts. Rosati et al (1996) indicated that refractory cytopenia with multilineage dysplasia (RCMD) is a distinct subset of MDS, with an unfavourable clinical outcome. We have also reported that the degree of myelodysplasia reflects the prognosis of MDS patients without increased blasts (Matsuda et al, 1998). Furthermore, we have devised a system for the more efficient discrimination of refractory anaemia cases, by employing parameters not only of cytopenias and cytogenetics, but also of morphology (Matsuda et al, 1999). We think that it is difficult to predict the prognosis of MDS patients presenting without increased blasts by MCV value alone.


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  2. References
  • Matsuda, A., Jinnai, I., Yagasaki, F., Kusumoto, S., Minamihisamatsu, M., Honda, S., Murohashi, I., Bessho, M. & Hirashima, K. (1998) Refractory anemia with severe dysplasia: clinical significance of morphological features in refractory anemia. Leukemia, 12, 482485.
  • Matsuda, A., Jinnai, I., Yagasaki, F., Kusumoto, F., Murohashi, I., Bessho, M., Hirashima, K., Honda, S., Minamihisamatsu, M., Fuchigami, K., Matsuo, T., Kuriyama, K. & Tomonaga, M. (1999) New system for assessing the prognosis of refractory anemia patients. Leukemia, 13, 17271734.
  • Rosati, S., Mick, R., Xu, F., Stonys, E., LeBeau, M.M., Larson, R. & Vardiman, J.W. (1996) Refractory cytopenia with multilineage dysplasia: further characterization of an ‘unclassifiable’ myelodysplastic syndrome. Leukemia, 10, 2026.
  • Tennant, G.B., Al-Sabah, A.I. & Burnett, A.K. (2002) Prognosis of myelodysplastic patients: non-parametric multiple regression analysis of populations stratified by mean corpuscular volume and marrow myeloblast number. British Journal of Haematology, 119, 8796.