Ringed sideroblasts in primary myelodysplasia. Leukemic propensity and prognostic factors

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Abstract
Among 123 patients with ringed sideroblasts on bone marrow aspirates, 85 had acquired ringed sideroblasts with primary myelodysplasia. The patients were placed in categories modified from the French-American-British classification based on percentages of ringed sideroblasts and myeloblasts in the initial bone marrow. Overall, 48% (41/85) of patients with myelodysplasia developed acute leukemia. Primary acquired sideroblastic anemia was the most favorable category with longer survival and 13.8% (4/29) leukemic conversions. Variables correlating with leukemic transformation included male sex, thrombocytopenia, neutropenia, and pseudo-Pelger-Huet neutrophils. Only two variables and independent predictive value by multivariate regression analysis: a high percentage of myeloblasts and a low percentage of ringed sideroblasts. Numerous ringed sideroblasts strongly predicts a more favorable course in myelodysplastic patients.