Ann Lab Med.  2014 Nov;34(6):426-432. 10.3343/alm.2014.34.6.426.

CD34 and p53 Immunohistochemical Stains Differentiate Hypocellular Myelodysplastic Syndrome (hMDS) from Aplastic Anemia and a CD34 Immunohistochemical Stain Provides Useful Survival Information for hMDS

• Cha CH
• Park CJ
• Chi HS
• Seo EJ
• Jang S
• Cho YU
• Lee KH
• Lee JH
• Lee JH
• Im HJ
• Seo JJ

• KMID: 2129567
• DOI: http://doi.org/10.3343/alm.2014.34.6.426

Abstract

BACKGROUND
The presence of significant dysplasia in bone marrow (BM) aspirates helps to distinguish between hypocellular myelodysplastic syndrome (hMDS) and aplastic anemia (AA). Occasionally, diluted BM aspirates make it difficult to recognize dysplastic changes and can also negatively affect the detection of cytogenetic abnormalities in hMDS. We evaluated the usefulness of CD34 and p53 immunoreactivity for discriminating between hMDS and AA and for estimating survival outcomes in hMDS patients.
METHODS
BM clot section (BMC) or BM biopsy (BMB) specimens were obtained from 64 hMDS/AA patients (33 with hMDS and 31 with AA) and seven controls. Immunohistochemical (IHC) staining for CD34 and p53 was performed by using the EnVision detection system (Dako, Denmark). We compared the results of IHC staining, BM findings, and chromosomal analyses, and determined overall survival outcomes.
RESULTS
The number of CD34- and p53-positive BM cells was higher among the patients with hMDS than among the patients with AA (P<0.001 and P=0.001, respectively). hMDS patients with increased CD34-positive cells had significantly poorer survival outcomes compared with those with normal number of CD34-positive cells (P=0.013).
CONCLUSIONS
CD34 and p53 IHC stains of BMC or BMB provide useful information for differentiating between hMDS and AA. CD34 IHC staining of BMC or BMB also provides useful information for estimating survival outcomes in hMDS patients.

Keyword

Hypocellular myelodysplastic syndrome; Aplastic anemia; Immunohistochemistry; CD34; p53

MeSH Terms

Adolescent
Adult
Anemia, Aplastic/*diagnosis
Antigens, CD34/*metabolism
Bone Marrow/metabolism/*pathology
Child
Chromosome Aberrations
Diagnosis, Differential
Female
Humans
Immunohistochemistry
Kaplan-Meier Estimate
Male
Middle Aged
Myelodysplastic Syndromes/*diagnosis/mortality
ROC Curve
Tumor Suppressor Protein p53/*metabolism
Antigens, CD34
Tumor Suppressor Protein p53

Figure

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  Fig. 1 Example of CD34+ (A) and p53+ (B) immunohistochemical stains in a patient with hypocellular myelodysplastic syndrome (bone marrow biopsy; immunohistochemical stain; original magnification ×400).

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  Fig. 2 Kaplan-Meier analysis comparing overall survival between the patients with hypocellular myelodysplastic syndrome (hMDS; N=33) and those with aplastic anemia (AA; N=31).

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  Fig. 3 Kaplan-Meier analysis for the overall survival of the patients with hypocellular myelodysplastic syndrome. The patients were divided into groups based on the CD34 immunohistochemistry status.

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