PROGNOSTIC IMPLICATIONS OF BONE-MARROW CULTURING IN MYELODYSPLASTIC SYNDROME - A RETROSPECTIVE ANALYSIS

To assess the predictive role of bone marrow culturing in MDS in vitro data of 205 patients were correlated with progression to AML and surv ival. Both in vitro growth pattern and in vitro differentiation were s ignificantly predictive for progression to AML. Other predictive param eters were FAB classification and the presence of cytogenetic abnormal ities in all metaphases analysed. Since FAB classification and in vitr o bone marrow culturing appeared confounding variables, the in vitro d ata were analysed for high risk patients, RAEB and RAEBt and low risk patients, RA and RARS. In 91/110 RAEBO) patients the estimated chance to develop AML was 25% in cases of normal growth versus 62% if abnorma l (p < 0.06). In 82/87 RA(RS) patients the estimated chance to develop AML was 5% and 40% respectively (p = 0.0004). After AML progression m edian survival was only 2 months (0-16.1 months). In RAEB(t) patients bone marrow culturing did not discriminate for better survival, althou gh a trend was shown. The estimated median survival was 16 months if g rowth was normal versus 8 months if abnormal (p = 0.07). In RA(RS) pat ients the median survival also was not significantly different, 31 ver sus 22 months respectively (p = 0.39). However, if in vitro growth and differentiation were both normal a significant difference in median s urvival was observed, 35 versus 22 months (p = 0.016). In conclusion, in vitro bone marrow culturing has predictive value for AML developmen t in RA(RS) patients. In RAEB(t), due to-many patients dying early in cytopenia, the predictive value is less pronounced. Especially normal growth in RA(RS) patients makes progression to AML very unlikely and t hese patients should be considered for a supportive approach. In RA(RS ) patients with normal growth and differentiation (about 25% of all pa tients) in vitro bone marrow culturing also predicts a better survival .