Journal of Rawalpindi Medical College (Mar 2015)
French American British (FAB) and World Health Organization (WHO) Subtypes of Myelodysplastic Syndromes and Bournemouth Scoring
Abstract
Background: To study the various FAB and WHO subtypes of MDS and prognostic stratification of patients at the time of their first presentation. Methods: In this cross-sectional study one hundred and thirty patients of MDS who were initially categorized by FAB criteria were studied. Clinical and laboratory data of these patients was re- evaluated and reclassified according to the WHO classification. Inclusion criteria was patients of all age groups presenting with low haemoglobin , neutropenia and/or thrombocytopenia and those having transfusion dependent anaemia. These patients also had peripheral blood film showing dysplastic changes ,hypo granular neutrophils, pseudo-pelger Huet anomalies, dyserythropoietic features or absolute monocyte count > 1.6x109/L. Patients having a known cause of pancytopenia, chronic infection, folate or B12 deficiency or concomitant malignancy and those who had received chemotherapy or radiotherapy were excluded. Diagnosis of MDS was made according to the proposals made by FAB as well as by WHO criteria. Marrow biopsy was assessed for abnormal localization of immature precursors (ALIP), lymphoid follicles and reticulin fibrosis. Bournemouth prognostic scoring system was applied to these patients, score was calculated by marrow blast percentage, haemoglobin level, platelet count and absolute neutrophil count. Results: Amongst 130 patients of MDS, 89 were males and 41 females. The median age of patients was 48 years (range 9-87 years). In FAB types refractory anaemia (RA) was the commonest, while according to WHO criteria Refractory Cytopenia with Multilineage Dysplasia (RCMD) was commonest .Peripheral blood counts revealed a varied spectrum of cytopenias ranging from anaemia, leucopenia, thrombocytopenia to pancytopenia. Eighteen (13.8%) cases were excluded while classifying the patients by WHO criteria; these included 05 cases of CMML and 13 cases of (RAEB-t) having blast cells between 20 and 30%.Majority of patients (57%) were found in group B; these were followed by 31.5% of patients in group C . Conclusion: WHO classification provides more homogenous morphological distribution in the subgroups of MDS and better prognostic information than FAB classification.
