Recommended hematologic surveillance for patients with SDS
| Goal of surveillance: identify patients with high risk features before the development of overt myeloid malignancies . | ||
|---|---|---|
| High risk features: | ||
| 1) Falling blood counts, particularly with increasing bone marrow cellularity | ||
| 2) Progressive bone marrow dysplasia (particularly in the erythroid lineage) | ||
| 3) Large and/or rapidly expanding TP53-mutated clones | ||
| 4) High-risk cytogenetic abnormalities (eg, -17p, -7/-7q, complex karyotype) |
| Goal of surveillance: identify patients with high risk features before the development of overt myeloid malignancies . | ||
|---|---|---|
| High risk features: | ||
| 1) Falling blood counts, particularly with increasing bone marrow cellularity | ||
| 2) Progressive bone marrow dysplasia (particularly in the erythroid lineage) | ||
| 3) Large and/or rapidly expanding TP53-mutated clones | ||
| 4) High-risk cytogenetic abnormalities (eg, -17p, -7/-7q, complex karyotype) |
| Clinical test . | Frequency . | Comments . |
|---|---|---|
| Peripheral blood monitoring | Every 3-6 mo | |
| CBC with differential | CBC monitoring alone is inadequate for hematologic surveillance of patients with SDS | |
| Reticulocyte count | ||
| Bone marrow examination | Every 12 mo∗ | |
| Aspirate | Assessment of morphologic dysplasia and blast count | |
| Core biopsy | Evaluation of marrow cellularity, dysplasia, and blast count | |
| Flow cytometry | Characterization of immature and aberrant immunophenotypic myeloid populations | |
| Somatic NGS panel | Detection of pathogenic somatic mutations, particularly involving TP53 | |
| Conventional karyotype | Detection of clonal cytogenetic abnormalities (eg, i7q, del20q) | |
| FISH | Increases sensitivity of detecting cytogenetic abnormalities | |
| TP53 immunostain | Optional | Screen for TP53 missense mutations |
| Microarray | Optional | Detection of copy number alterations, particularly involving 17p |
| Clinical test . | Frequency . | Comments . |
|---|---|---|
| Peripheral blood monitoring | Every 3-6 mo | |
| CBC with differential | CBC monitoring alone is inadequate for hematologic surveillance of patients with SDS | |
| Reticulocyte count | ||
| Bone marrow examination | Every 12 mo∗ | |
| Aspirate | Assessment of morphologic dysplasia and blast count | |
| Core biopsy | Evaluation of marrow cellularity, dysplasia, and blast count | |
| Flow cytometry | Characterization of immature and aberrant immunophenotypic myeloid populations | |
| Somatic NGS panel | Detection of pathogenic somatic mutations, particularly involving TP53 | |
| Conventional karyotype | Detection of clonal cytogenetic abnormalities (eg, i7q, del20q) | |
| FISH | Increases sensitivity of detecting cytogenetic abnormalities | |
| TP53 immunostain | Optional | Screen for TP53 missense mutations |
| Microarray | Optional | Detection of copy number alterations, particularly involving 17p |
A shorter interval between bone marrow biopsies may be indicated if HRFs are present.