The proliferative activity of bone marrow cells was studied in 24 patients with primary dysmyelopoiesis by means of flow cytometry and 3H-TdR autoradiography. Abnormal DNA content was found in two cases with aneuploid karyotypes. DNA content typical of a diploid population was observed in all patients with normal karyotype and in three patients with chromosomal aberrations. The fraction of bone marrow cells in Sand G2-phase was higher in primary acquired sideroblastic anemia and refractory anemia (without excess of blasts) than in refractory anemia with excess of blasts and chronic myelomonocytic leukemia. Regardless to the diagnosis, the patients with low fraction of cells in Sand G2-phase had short survival time and showed high rate of evolution into acute nonlymphoblastic leukemia. The labeling (IA) and mitotic (MI) indexes of both erythroblasts and granulocytic cells were decreased in nearly all patients. The lowest values of LI and MI of the granulocytic compartment were found in the patients who subsequently developed acute leukemia. These data suggest that cytokinetic analysis allows investigators to achieve useful information on the stage of disease in the dysmyelopoietic syndromes.
Cancer 52:1190-I 195, 1983.
YSMYELOPOIETIC syndromes group a spectrum of D acquired diseases characterized by qualitative and quantitative defects of hemopoiesis. Although they are commonly considered preleukemic states,'-' the fatal outcome into acute nonlymphoblastic leukemia is not a constant feature. Many patients die in fact from complications due to cytopenia without developing leukemia, and others survive for several years with a stable clinical course. The percentage of myeloblastsh-x and of ringed sideroblasts4 in the bone marrow. are considered as relevant factors influencing the prognosis. The growth pattern in vitro (CFU-c assay)6.'.'(' and the presence of cytogenetic abnormalities' '.I' were also tested to this end. However, currently it is still impossible to determine the outcome of the disease on the basis of these parameters in the individual patient.x Although already documented in refractory anernia'"l4 and preleukemia,'5.'6 cytokinetic abnormalities of bone marrow cells have received only little attention with regard to prognosis.'.'' We approached this problem using From the Istituto di Patologia Medica 1. and