Diagnostic and clinical relevance of the number of circulating CD34(+) cells in myelofibrosis with myeloid metaplasia

The absolute content of CD34(+) cells in the peripheral blood of 84 patient s with myelofibrosis with myeloid metaplasia (MMM) and 23 patients with oth er Philadelphia-negative (Ph-) chronic myeloproliferative disorders (CMDs) was investigated. In MMM, the median absolute number of circulating CD34(+) cells was consistently high (91.6 x 10(6)/L; range, 0-2460 x 10(6)/L). Rec eiver operating characteristic curve analysis showed that 15 x 10(6)/L as a decision criterion for CD34(+) cells produced an almost complete discrimin ation between MMM patients out of therapy and other Ph- CMDs (positive pred ictive value, 98.4%; negative predictive value, 85.0%). MMM patients with h igher numbers of CD34+ cells had a significantly longer disease duration (P = .019) and higher spleen volume index (P = .014), liver volume (P = .000) , percentage of circulating immature myeloid cells (P = .020), and percenta ge of myeloid blasts (P = .000). When CD34(+) cells were correlated with th e use of Dupriez risk stratification, CD34(+) cells increased significantly from low-risk (median, 68.1 x 10(6)/L) to intermediate-risk (median, 112.8 x 10(6)/L) and high-risk patients (median 666.1 x 10(6)/L) (F = 4.95; P = .009). When CD34(+) cells were correlated with a severity score on the basi s of both myeloproliferative and myelodepletive characteristics of the dise ase, only the myeloproliferation index was significantly associated with CD 34(+) cell level (F = 5.7; P = .000). Overall survival and interval to blas t transformation from the time of CD34(+) cell analysis were significantly shorter in patients with more than 300 x 10(6)/L CD34(+) cells (P = .005 an d .0005, respectively). In conclusion, the absolute number of CD34(+) circu lating cells allows MINIM to be distinguished from other Ph- CMDs; it is st rongly associated with the extent of myeloproliferation and predicts evolut ion toward blast transformation. (Blood. 2001;98:3249-3255) (C) 2001 by The American Society of Hematology.