PRELEUKEMIC SYNDROME - CORRELATION OF INVITRO PARAMETERS OF GRANULOPOIESIS WITH CLINICAL-FEATURES

In vitro parameters of granulopoiesis were correlated with the clinical courses of 43 prospectively studied patients with the preleukemic syndrome. Clinical features of these cytopenic patients with marrow morphology showing hemopoietic dysplasia included the following: median age, 61 years; combined cytopenias, 60 per cent; low leukocyte alkaline phosphatase, 67 per cent; splenomegaly, 33 per cent; median survival, 18.9 months; and a 55 per cent two year actuarial probability of survival. Transformation into acute myeloid leukemia occurred in 19 patients (44 per cent) within a median period of 19.1 months. Presenting pancytopenia was the only clinical feature indicative of subsequent acute transformation, with 69 per cent of these patients undergoing such evolution within a median period of 15 months. Lethal infections were frequent during the preleukemic period. Abnormalities of in vitro marrow myeloid clonal growth were initially present in 72 per cent of the patients showing significantly low granulocyte-monocyte colony forming cell (CFU-GM) values and a high proportion of light density CFU-GM. Persisting or progressive decrements in CFU-GM sequentially occurred prior to or concomitant with acute transformation in six patients. Markedly diminished initial CFU-GM values (≤2 colonies/105 marrow cells) were predictive for a significantly decreased (19 per cent) two year probability of survival (p < 0.004), whereas no clinical feature showed this association. Marrow cell and urinary colony-stimulating activity output were normal during the chronic phase of the disorder. These in vitro myeloid culture studies are useful adjuncts to marrow morphology and clinical features for diagnostic and prognostic characterization of patients with this syndrome. © 1979.