MULTILINEAGE DYSPLASIA IN IRAQI KURDS WITH ACUTE MYELOID LEUKEMIA: A RETROSPECTIVE STUDY ON 105 PATIENTS

KHAMLEEN M. HASAN; NASIR A. S. AL-ALLAWI; AMEER I. A. BADI

KHAMLEEN M. HASAN Department of Hematology, Azdi Teaching Hospital, Duhok, Kurdistan Region, Iraq.
NASIR A. S. AL-ALLAWI Department of Pathology, College of Medicine, University of Duhok, Kurdistan Region, Iraq.
AMEER I. A. BADI Department of Pathology, College of Medicine, University of Duhok, Kurdistan Region, Iraq.

Keywords: AML, Multilineage Dysplasia

Abstract

https://doi.org/10.31386/dmj.2017.11.2.1

Background: Acute Myeloid leukemia (AML) with multilineage dysplasia (MLD) is an important subcategory of acute myeloid leukemia, which has been reported to have prognostic importance. No studies have addressed this category of AML in Iraq Kurds, so this study was initiated.

Subject and Methods: A total of 105 patients diagnosed as Acute Myeloid leukemia over 10 years were reassessed. They have a median age of 40 and a male: female ratio of 1.02:1. The reassessment included re-evaluation of their clinical and hematological records, as well as re-evaluation of their peripheral blood and marrow smears for multilineage dysplasia. The study also included assessing any correlations between various clinical and hematological parameters and the presence of MLD.

Results: Multilineage dysplasia was documented in 35.3% of cases. The dysplasia was bilineage in 23.8% and trilineage in 11.4%. The most frequent dysplastic changes were hypogranular granulocytes, pseudo-pelger-hüet anomely, and mono-lobated megakaryocytes, seen in 46.6%, 29.5% and 20.9% respectively. The dysplasia was encountered in most frequently in M5 and M6 morphological subtypes, while it was absent in the M3 subtype, a finding which was significant (p =0.001). When the latter subtype was excluded from evaluation, it was found that patients with MLD were less likely to have organomegaly, more likely to have leukopenia, platelets < 20x10⁹/l, blast <20% in peripheral blood or <60% in bone marrow than those with no MLD, although none was significant.

Conclusions: Multilineage dysplasia is frequently encountered in Iraqi Kurds with AML and seen in all morphological subtypes except M3, and its presence needs to be documented in bone marrow reports on new AML cases. Further prospective studies preferably including cytogenetics to evaluate outcome in AML-MLD versus AML without it, needs to be initiated.

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