The Application Of Flow Cytometric Analysis Of Bone Marrow Cells For The Diagnosis And Prognosis Of Myelodysplastic Syndromes [contribuição Da Citometria De Fluxo Para O Diagnóstico E Prognóstico Das Síndromes Mielodisplásicas]

The diagnosis of MDS is based on the presence of peripheral cytopenias together with cell atypias in bone marrow precursors and cytogenetic abnormalities. However, in several cases, the cell atypias are discrete, and/or the karyotype is normal, precluding a clear-cut diagnosis. Multiparametric flow cytometry is a fast, reproducible and relatively inexpensive technique, which is able to disclose changes in the expression of lineage and maturation related antigens. Several of such abnormalities have been described in MDS. Three or four-color protocols have been used to analyze erythroblasts, granulocytes, monocytes and blasts, permitting, in most of the cases, the differential diagnosis between MDS and non-clonal disorders presenting pancytopenia. Flow cytometry is also useful in the follow-up of the patients, since it has been described that progression of the MDS clone is accompanied by an increase in the number of phenotypic abnormalities and of CD34+ cells, as well as the decrease in pro-apoptotic markers in bone marrrow cells.283178181Lorand-Metze, L., Pinheiro, M.P., Ribeiro, E., Paula, E.V., Metze, K., Factors influencing survival in myelodysplastic syndromes in a Brazilian population: Comparison of FAB and WHO classifications (2004) Leukemia Res, 28, pp. 587-594Lorand-Metze, I., Meira, D.G., Lima, C.S.P., Vassallo, J., Metze, K., The differential diagnosis between aplastic anemia and hypocellular myelodysplasia in patients with pancytopenia (1999) Haematologica, 84, pp. 564-565Magalhães, S.M.M., Lorand-Metze, I., Síndromes mielodisplásicas: Protocolo de exclusão (2004) Rev Bras Hematol Hemoter, 26, pp. 263-267Magalhães SMM, Rocha Filho FD, Vassallo J, Lorand-Metze I. Nódulos linfóides medulares. Rev Bras Hematol Hemoter 200325:81-87Béné MC, Feuillard J, Bernard H, Maynadié M, and the GEIL. Immunophenotyping of myelodysplasia. Clin Appl Imunol Rev 20055:133-148Stetler-Stevenson, M., Arthur, D.C., Jabbour, N., Xie, X.Y., Molldrem, J., Barret, J., Diagnostic utility of flow cytometry immunophenotyping in myelodysplastic syndrome (2001) Blood, 98, pp. 979-987Del Cañizo, M.C., Fernandez, E., López, A., Vidriales, B., Villarón, E., Arroyo, J.L., Immunophenotypic analysis of myelodysplastic syndromes (2003) Haematologica, 88, pp. 402-407Wells, D.A., Benesch, M., Loken, M.R., Vallejo, C., Myerson, D., Leisernring, W.M., Myeloid and monocytic dyspoiesis as determined by flow cytometry scoring in myelodysplastic syndromes correlates with the IPSS and with outcome after hemopoietic stem cell transplantation (2003) Blood, 102, pp. 394-405Kussick, S.J., Fromm, J.R., Rossini, A., Ying, L., Chang, A., Norwood, T.H., Four color flow cytometry shows strong concordance with bone marrow morphology and cytogenetics in the evaluation for myelodysplasia (2005) Am J Clin Pathol, 124, pp. 170-181Orfao, A., Ortuño, F., De Santiago, M., Lopez, A., San Miguel, J.F., Immunophenotyping of acute leukemias and myelodysplastic syndromes (2004) Cytometry, 58, pp. 62-71Ogata, K., Nakamura, K., Yokose, N., Tamura, H., Tachibana, M., Tanigushi, O., Clinical significance of phenotypic features of blasts in patients with myelodysplastic syndromes (2002) Blood, 100, pp. 3887-3895Xu, D.S., Schultz, C., Akker, Y., Cannizzaro, L., Ramesh, K.H., Juan, D.U., Evidence for expression on early myeloid antigens in mature, non-blast myeloid cells in myelodysplasia (2003) Am J Haematol, 74, pp. 9-16Parker, J.E., Mufti, G.J., Rassol, F., Mijovic, A., Devereux, S., Pagliuca, A., The role of apoptosis, proliferation and the bcl-2-related proteins in the myelodysplastic syndromes and acute myeloid leukemia secondary to MDS (2000) Blood, 96, p. 3932Ribeiro, E., Lima, C.S.P., Metze, K., Lorand-Metze, I., Flow cytometry analysis of the expression of Fas/Fas-L in bone marrow CD34+ cells in myelodysplastic syndromes. Relation to disease progression (2004) Leukemia & Lymphoma, 45, pp. 309-313Ribeiro, E., Matarraz Sudón, S., Santiago, M., Lima, C.S.P., Metze, K., Giralt, M., Maturation-associated immunophenotypic abnormalities in bone marrow B-lymphocytes in myelodysplastic syndromes (2006) Leuk Res, 30, pp. 9-16Van Lochem, E.G., Van Der Velden, V.H.J., Wind, H.K., Marvelde, J.G., Westerdaal, N.A.C., Van Dongen, J.J.M., Immunophenotypic differentiation patterns of normal hematopoiesis in human bone marrow: Reference patterns for age-related changes and disease-induced shifts (2004) Cytometry, 60, pp. 1-13Dunphy, C.H., Orton, S.O., Mantell, J., Relative contributions of enzyme cytochemistry and flow cytometric immunophenotyping to the evaluation of acute myeloid leukemias with a monocytic component and of flow cytometric immunophenotyping to the evaluation of absolute monocytoses (2004) Am J Clin Pathol, 122, pp. 865-874Lorand-Metze, I., Ribeiro, E., Lima, C.S.P., Batista, L.S., Metze, K., Detection of hematopoietic maturation abnormalities by flow cytometry in myelodysplastic syndromes and its utility for the differential diagnosis with nonclonal disorders Leukemia Res, , in pressMalcovati, L., Germing, U., Kuendgen, A., Della Porta, M.G., Invernizzi, R., Giagounidis, A., A.. WHO classification-based prognostic scoring system (WPSS) for predicting survival in myelodysplastic syndromes (2005) Blood, 106, pp. 232a-233aCosta, F.P.S., Pereira, F.G., Vassallo, J., Freitas, L.L.L., Lorand-Metze, I., A utilidade da citologia por punção com agulha fina aliada a imunofenotipagem no diagnóstico dos linfomas não Hodgkin (2005) Rev Bras Hematol Hemoter, 27, pp. 16-20Lorand-Metze, I., O tratamento da leucemia mielóide aguda no Brasil: O que já progredimos e o que podemos melhorar (2003) Rev Bras Hematol Hemoter, 25, pp. 1-