Analysis of blood component transfusion and some adverse reactions in myelodysplastic syndroms patients / 中国输血杂志

【Objective】 To analyze the blood transfusion and adverse reactions in myelodysplastic syndroms (MDS) patients, so as to improve transfusion management in MDS patients. 【Methods】 The diagnosis and treatment information of MDS patients with blood transfusion in our hospital from January 2003 to December 2022 were collected, and the component transfusion and adverse reactions were investigated. 【Results】 The average infusion volume of red blood cells(RBCs) and platelets were respectively (27.46±43.11 ) and (16.41±24.81 ) in 799 MDS patients, which had no correlation with gender and blood type. The incidence of adverse reactions was 18.27% (146/799), with the most common adverse reactions as delayed serologic transfusion reaction (DSTR) (9.01%, 72/799), followed by non hemolytic fever reaction (4.76%, 38/799) and allergic reaction (4.38%, 35/799). Compared with all patients with transfusion, DSTR was more common in females (P<0.05), with elder age and had more RBCs consumption (all P<0.01). 86.11%(62/72) were Rh system, and 40.28% (29/72) had 2 or more antibodies. The occurrence time of DSTR in some patients was not related to the volume of RBCs trans infusion. 【Conclusion】 MDS patients, with more average transfusion volume and higher incidence of adverse reactions especially DSTR, were recommended a strictly limited transfusion schedule and Rh phenotype matching RBC products. The investigation of immune status of MDS patients at different periods is helpful to provide new aspects and therapeutic measures for the pathogenesis of DSTR, and the antibody screening time may adjusted appropriately.

The phenotypic and genetic spectrum of colony-stimulating factor 1 receptor gene-related leukoencephalopathy in China / 中华神经科杂志

Objective:To summarize and analyze the clinical data of Chinese patients with colony-stimulating factor 1 receptor (CSF1R)-related leukoencephalopathy, and clarify the phenotypic and genetic characteristics of Chinese patients.Methods:Medical history of patients with CSF1R-related leukoencephalopathy diagnosed from April 1, 2018 to January 31, 2021 in the department of neurology of 22 hospitals in China was collected, and scores of Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment Scale (MoCA), magnetic resonance severity scale were evaluated. Group comparison was performed between male and female patients.Results:A total of 62 patients were included, and the male-female ratio was 1∶1.95. The age of onset was (40.35±8.42) years. Cognitive impairment (82.3%, 51/62) and motor symptoms (77.4%,48/62) were the most common symptoms. The MMSE and MoCA scores were 18.79±7.16 and 13.96±7.23, respectively, and the scores of two scales in male patients (22.06±5.31 and 18.08±5.60) were significantly higher than those in females (15.53±7.41 , t=2.954, P=0.006; 10.15±6.26, t=3.328 , P=0.003). The most common radiographic feature was bilateral asymmetric white matter changes (100.0%), and the magnetic resonance imaging severity scale score was 27.42±11.40, while the white matter lesion score of females (22.94±8.39) was significantly higher than that of males (17.62±8.74 , t=-2.221, P<0.05). A total of 36 CSF1R gene mutations were found in this study, among which c.2381T>C/p.I794T was the hotspot mutation that carried by 17.9% (10/56) of the probands. Conclusions:The core phenotypic characteristics of CSF1R-related leukoencephalopathy in China are progressive motor and cognitive impairment, with bilateral asymmetrical white matter changes. In addition, there exist gender differences clinically, with severer cognitive impairment and imaging changes in female patients. Thirty-six CSF1R gene mutations were found in this study, and c.2381T>C/p. I794T was the hotspot mutation.

Study of iron overload assessment by T2* magnetic resonance imaging in patients with myelodysplastic syndromes / 中华血液学杂志

Objectives@#To analyze the cardiac T2* value, liver iron concentration (LIC) , and related laboratory parameters in myelodysplastic syndrome (MDS) with iron overload and evaluate the changes of organ functions after iron chelation therapy. To explore the value of magnetic resonance imaging (MRI) T2* in making early diagnosis and assessing organs iron overload.@*Methods@#Retrospective investigation was used to observe the cardiac T2* value, LIC, iron metabolism parameters and related laboratory parameters of 85 MDS patients from Nov 2014 to Jan 2018. Among them, 7 MDS patients with Low/Int-1 have received iron chelation therapy for 6 months during two MRI examinations. The above parameters were collected before and after iron chelation therapy for comparison.@*Results@#Correlations were found between heart T2* value and age (rs=-0.290, P=0.007) and left ventricular ejection fraction (LVEF) (rs=0.265, P=0.009) . There was a significant negative correlation between heart T2* value and blood transfusion units (rs=-0.701, P<0.001) . There was a significant positive correlation between LIC and serum ferritin (SF) (rs=0.577, P<0.001) . There was also a correlation between LIC and ALT (rs=0.268, P=0.014) and blood transfusion units (rs=0.244, P=0.034) . There was no correlation between heart T2* and pro-BNP, SF (all P>0.05) , and no correlation between LIC and age (P>0.05) . The increase of heart T2* between the normal and abnormal groups was statistically significant (P=0.005) , but the iron overload ratio of the heart T2*<20 ms was not significant between the two groups. There was statistical significance in the proportion of severe liver iron overload (LIC>15 mg/g DW) (P=0.045) . After iron chelation therapy, the values of SF, transferrin saturation, ALT, AST, pro-BNP and LIC of 7 patients were decreased compared with values before iron chelation therapy, and the peripheral blood cell level was increased. However, the changes of LVEF and T2* values after iron chelation were not obvious.@*Conclusion@#MRI T2* may be a predictor of iron overload in patients with MDS in early stage, and may be more valuable compare with LVEF, SF and other laboratory indicators. The safety and repeatability of MRI cardiac T2* examination are recognized, and it can be used as an ideal detection for patients with iron overload.

Predict response to decitabine in patients with myelodysplastic syndrome and related neoplasms / 中华血液学杂志

Objective@#To identify clinical and molecular signatures for predicting response to decitabine (DAC) in patients with myelodysplastic syndrome (MDS) and related neoplasms.@*Methods@#The clinical characteristics of 109 patients with MDS and related neoplasms who were treated with DAC were analyzed retrospectively and the next target sequencing was performed to define recurrently mutated genes in these disease samples, to examine the association of the clinical and molecular signatures with response to DAC treatment.@*Results@#Of 109 MDS and related neoplasms patients, there were 70 males and 39 females, the median age was 61 years old (ranges: 17-85 years old) . According to the international prognostic scoring system (IPSS) , 46 cases were included in the relatively low risk group (low risk and intermediate-1 risk) , 63 in the relative high risk group (intermediate-2 and high risk) . There were 21 cases with complex karyotype, 17 chromosome 7 abnormality and 17 monosomal karyotype. The median courses of DAC treatment was 4 (2-11) . A total of 74 patients achieved response (67.9%) and 30 (27.5%) achieved complete response (CR) . Univariate analysis found that CR was higher in patients with high risk of IPSS, complex karyotypes, monosomal karyotypes, chromosome 7 abnormality, and platelet doubling after one cycle of DAC treatment. Patients with TP53 gene mutation were more likely to receive CR, 10 of 15 patients with TP53 mutations achieved CR. (66.7%) , which was significantly higher than that of the patients without TP53 gene mutation (21.3%) (P=0.001) . Multivariate analysis showed that TP53 gene mutation, platelet doubling after one cycle of DAC treatment and the complex karyotype were independent prognostic factors for CR. Of them, TP53 gene mutation is the strongest predictor (OR=4.39, 95%CI, 1.20-16.06, P=0.026) .@*Conclusion@#TP53 mutation, platelet doubling after one cycle of DAC treatment and complex karyotypes could predict CR to DAC.

Recurrent Abnormal Clones in Myelodysplastic Syndrome Marrow Originate from Cells at a Pluripotent Stem Level and Maintain Their Early Differentiation Potency.

OBJECTIVE: The present study aimed to investigate the origins and differentiation potencies of 4 common malignant clonal cell types (+8, 5q-/-5, 20q-/-20, 7q-/-7) in myelodysplastic syndrome (MDS) and to investigate whether the trisomy of chromosome 8 occurs subsequently to other chromosomal abnormalities. METHODS: The present study analyzed a total of 46 cases of chromosomal abnormalities in MDS patients. The magnetic activated cell sorting technique (MACS) was used to sort the CD34(+)CD38(-) (pluripotent hematopoietic stem cells) and CD34(+)CD38(+) cells (committed progenitor cells) from the bone marrow mononuclear cells (BMNCs) of these patients; the sorted cells were then individually smeared. Meanwhile, cytospins were prepared from the remaining CD34(-) BMNCs after cell sorting. The clonal cell proportions in these three types of smears were detected by fluorescence in situ hybridization (FISH). Cases in which +8 was associated with another abnormality (2 cases each in combination with abnormalities in chromosomes 7, 5, and 20) were dually hybridized with the cep8 probe and another corresponding probe. RESULTS: (1) for abnormalities of +8, 5q-/-5, 20q-/-20 or chromosome 7 involvements, clonal cells above the baseline level were detected in the pluripotent stem cell level. (2) The average clonal cell proportion in the committed progenitor cells of the 46 cases increased to 75.3% from 57.3% at the level of stem cell (p < 0.001). The groups with +8 and chromosome 5 abnormalities showed a statistically significant increase in clonal cells at the progenitor cell stage. At the individual level, 33 of 46 cases showed significant increases in clonal cells at the progenitor cell stage relative to the stem cell stage, whereas the clonal cell proportion in the CD34(-) BMNCs generally did not increase relative to the committed progenitor cell population. (3) The dual hybridization analysis showed that if +8 and another abnormality were present in the same abnormal clone according to G-banding, +8 always coexisted with the other chromosomal abnormality at the single cell level; there were no situations in which +8 occurred later than the other chromosomal abnormality. CONCLUSION: It seems that the all malignant MDS clones originated at the pluripotent hematopoietic stem cell stage and that the proliferation and differentiation potencies were retained partly in these clonal cells. The present study failed to confirm that the trisomy 8 occurred subsequently to the other abnormalities, but some in vitro or transplant experiments maybe prove the succession of clonal origination.

Decitabine treatment could ameliorate primary iron-overload in myelodysplastic syndrome patients.

In order to research how does hypomethylating agents ameliorate iron metabolism in myelodysplastic syndrome (MDS), we performed methylation-specific, polymerase chain reaction (MSP), bisulfate genomic sequencing polymerase chain reaction (BSP), quantitative real-time PCR and western blot of hemojuvelin (HJV) and ELISA assay for hepcidin before and after demethylating therapy (decitabine) to determine whether the change of HJV methylation status would have an influence on hepcidin expression. Eleven of 22 MDS patients achieved CR or PR according to IWG criteria (50%). HJV mRNA was induced in decitabine responders (p = .006 comparing pre/post decitabine treatment) but not in non-responders (p = .121). Similarly, hepcidin serum expression increased from 320.77 ± 34.8 µg/L to 366.77 ± 21.90 µg/L (p = .012) in responders but did not significantly change in non-responders (p = .058), while no difference of adjusted serum ferritin (ASF) was found. In conclusion, hypermethylation of HJV promoter region could silence the gene expression and demethylating therapy might ameliorate iron-overload through HJV demethylation.

MRI for assessment of iron overload in patients with hematologic disease / 中华血液学杂志

<p><b>OBJECTIVE</b>Compare the characteristics of magnetic resonance imaging（MRI）liver T2*, cardiac T2* and serum ferritin on the assessment of iron overload.</p><p><b>METHODS</b>A total of sixty-nine patients from November 2011 to June 2014 were enrolled in this study. Their cardiac and liver iron concentration levels were measured through MRI examination, with other clinical data were collected to perform statistical analysis.</p><p><b>RESULTS</b>The correlation between liver T2* and adjusted serum ferritin（ASF） was statistically significant（P=0.003）. However, no significant correlation was found between cardiac T2* and liver T2*, ASF, respectively. According to the statistical analysis of the 69 cases, it is found that the number of iron overload cases diagnosed by liver T2* was 62 and 20 cases were severe iron overload （32.26%）; the number of iron overload cases diagnosed by ASF was 47 and 14 cases were severe iron overload（29.79%）, while the number of iron overload cases diagnosed by cardiac T2* was only 25 and no severe iron overload cases.</p><p><b>CONCLUSION</b>Since SF was affected by other factors, it cannot reflect the level of iron overload in human body objectively. Now, liver T2* has become the gold standard for assessment of iron overload because of its good reliability and repeatability. However, cardiac T2* cannot correctly be used as assessment for iron overload, and it is only a method of evaluating the level of cardiac iron deposition.</p>

Functional study of hENT1 on SKM-1 cell resistance to decitabine / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the effect of human equilibrative nucleoside transporters 1 (hENT1) silencing on proliferation, apoptosis and demethylation of human myelodysplastic syndrome (MDS) derived cell line SKM-1 treated with 5-aza-2'-deoxycytidine (decitabine, DAC).</p><p><b>METHODS</b>hENT1 was silenced in SKM-1 cells mediated by lentivirus transfection. The infection efficiency was detected by flow cytometry, and the mRNA expression level of hENT1 was confirmed by qRT-PCR. The proliferation ratio of SKM-1 cells treated with different concentrations (0.5, 1, 5 mmol/L) of DAC for 24, 48 and 72 h was detected by CCK-8 method after hENT1 silencing. The apoptosis of SKM-1 cells was detected by Western blot for cleaved level of caspase-3 and evaluated by flow cytometry after staining with anti-Annexin V-PE and 7-AAD. The p15(INK4B) DNA methylation status was measured by methylation specific PCR using EZ DNA Methylation-Gold™ Kit.</p><p><b>RESULTS</b>The expression level of hENT1 silenced group (0.253±0.030) was statistically decreased compared with that in control group (1.000±0.091) (P<0.01). Compared with control, the proliferation inhibition rate of hENT1 silenced group was significantly decreased by different concentrations of DAC (0.5, 1, 5 μmol/L) treatment for 24, 48, 72 h (P<0.05), which was (49.41±4.02)% and (33.03±2.47)%, respectively (P=0.007) at 5 μmol/L DAC treatment for 72 h in hENT1 silenced group and the control group. Western blot showed that cleaved caspase3 of hENT1 silenced group was also significantly inhibited. The percentage of Annexin Ⅴ⁺ cells and demethylation status of p15(INK4B) were significantly decreased.</p><p><b>CONCLUSION</b>Apoptosis of hENT1 silenced SKM-1 cells induced by DAC was decreased, and the susceptibility of these cells to demethylation treatment was also decreased.</p>

Multisystem Langerhans cell histiocytosis with diabetes insipidus as the first symptom: a case report and literature review / 白血病·淋巴瘤

Objective To study the clinical features and differential diagnosis of Langerhans cell histiocytosis (LCH).Methods A case of LCH was reported and the literatures were reviewed.Results The of multisystem LCH patient,presented with a diabetes insipidus (DI) and panhypopituitarism,was 44 years old,and developed costal,tibial and femoral multiple lesions.The final diagnosis as LCH was made based on biopsy of tibia and lymph nodes.The biopsy specimen showed that the cells were infiltrated exhibiting the characteristic morphologic features of Langerhans cell (LC) with a convoluted shape,elongated nuclei exhibiting longitudinal grooves,and immunohistochemistry results revealed positive LC for the S-100,CD1a and Langerin immunostaining.Conclusions LCH may range from a solitary lytic bone lesion (for example eosinophilic granuloma) with a favorable course to a fatal disseminated leukaemia-like form.LCH typically involves the bone,lesions almost can be found in all organs.DI and CNS involvement often present as a puzzling syndrome,which renders the diagnosis problematicly,and often delays the diagnosis of LCH.The damage to the pituitary/hypothalamus axis results in life-long hormonal replacement therapy.

The roles of SDF-1/CXCR4 axis and its relationship with apoptosis in the myelodysplastic syndromes.

We performed flow cytometric analysis of CD34(+) cell apoptosis in 22 patients with myelodysplastic syndrome (MDS) and 7 patients with de novo acute myeloid leukemia (AML) using annexin V-FITC, which binds to exposed phosphatidylserine on apoptotic cells. Apoptosis was significantly increased in low-grade MDS group (IPSS score ≤ 1.0) compared with high-grade MDS group (21.33 vs. 7.27%, P < 0.001) and patients with de novo AML (21.33 vs. 7.53%, P < 0.001). There was no correlation between apoptosis and patient's age or gender. Our results confirmed that CD34(+) cell apoptosis was significantly increased in low-grade MDS, which was featured as bone marrow failure. CXCR4 protein expression on CD34(+) cell surface in the low-grade MDS was lower than high-grade MDS (10.42 vs. 16.97, P = 0.014) and AML group (10.42 vs. 20.26, P < 0.001). But there was no statistical significance between low-grade MDS and the control group (P = 0.496). Furthermore, we measured SDF-1 levels in BM plasma from patients by enzyme-linked immunosorbent assay (ELISA), and no difference was found. We found a negative correlation between apoptosis and CXCR4 expression. Our data indicate that CXCR4 might be the prognostic marker of MDS.

In vitro deprivation of CD8(+)CD57(+)T cells promotes the malignant growth of bone marrow colony cells in patients with lower-risk myelodysplastic syndrome.

OBJECTIVE: CD8(+)T lymphocytes have inhibitory effects on the proliferation of malignant clones in myelodysplastic syndrome (MDS). The exact CD8(+)T subset involved in the regulation of MDS and the target clones of CD8(+)T lymphocytes has not been studied. We investigated the effect of activated CD8(+)T (CD8(+)CD57(+)) lymphocytes on colony formation (in particular, malignant colony formation) during MDS in vitro. MATERIALS AND METHODS: Bone marrow mononuclear cells (BMNCs) from a total of 59 MDS patients were subjected to magnetic-activated cell sorting to separate CD8(+)CD57(+)T lymphocytes. BMNCs were cultured without CD8(+)CD57(+)T cells or cocultured with a 1:4 ratio of CD8(+)CD57(+)T cells to study the association between stem/progenitor cell colony formation and the existence of activated CD8(+) T cells, as well as the polarization of T cells towards Tc1. In addition, the fluorescence in situ hybridization method was used to detect bone marrow cells carrying abnormal karyotypes, and the proportion of abnormal cells among BMNCs was calculated before and after T-cell deprivation culture in vitro. Crossing cultures between MDS patients and normal volunteer was performed. The impact of effector CD8(+)T cells on the malignant growth of BMNCs was closely examined. RESULTS: After deprivation of CD8(+)CD57(+)T cells, BMNCs from 33 MDS patients formed colonies in the culture media. The average number cells in the granulocyte and monocyte colony-forming units (CFU-GM) was 40.3/4 x 10(5), and the average number of cells in the erythroid colony-forming unit (CFU) was 10.4/4 x 10(5). These totals were significantly lower than those in the normal control group after deprivation of CD8(+)CD57(+)T cells (CFU-GM 83.4/4 x 10(5) cells, erythroid CFU 32.8/4 x 10(5) cells; p < 0.001). After add-back of CD8(+)CD57(+) T cells (four times), none of the BMNCs cultures from any of the 59 MDS patients formed colonies in vitro. Additionally, in 33 MDS patients whose BMNCs formed colonies after T-cell deprivation, the bone marrow Tc1/Tc2 ratio was positively correlated with CFU-GM count (r = 0.443, p < 0.05). Crossing cultures indicated that CD8(+)CD57(+) T cells from MDS patients cocultured with BMNC from normal donor did not show inhibition to colony-forming. In 15 MDS patients with abnormal karyotypes, deprivation of CD8(+)CD57(+)T cells significantly increased the proportion of abnormal cells from 43.8% to 56.3% in BMNC culture (p < 0.001). CONCLUSION: Effector CD8(+)T lymphocytes inhibit bone marrow hematopoiesis in MDS patients; target cells were primarily cells with abnormal karyotypes.

Treatment of a elderly patient of myelodysplastic syndrome-ring sideroblastic refratory anemia with decitabine and review of literatures / 白血病·淋巴瘤

Objective To study the effect of decitabine treating elderly patient with myelodysplastic syndrome-ring sideroblastic refractory anemia (MDS-RAS) and review the literatures. Methods Decitabine treated a patient with MDS-RAS four courses, at the dose of 25 mg everyday for 5 days per course. Observed the change of symptoms, peripheral blood cell counts, myelogram, T cell polarization, cellular immunity,chromosome. Determined the curative effect combined with efficiency standard of WHO 2008. Results The clinical symptoms got better after two courses. Peripheral blood cell counts began to get better after one course. The number of leukocyte, hemoglobin and platelet got nearly normal after four courses. After two courses, T cell polarization state got normal, the number of iron ring promyelocyticin bone marrow declined from 16 % to 0 and chromosome changed from complex karyotype to normal. Conclusion Decitabine is an effective drug to the old patient with MDS-RAS. But it needs to increase the number of cases and follow up long-term to observe the effective rate and long-term efficacy.

Advances on the methods of enhancing the immunological functions of exosomes / 白血病·淋巴瘤

Exosomes are membrane vesicles released into the extracellular environment upon exocytic fusion of multivesicular bodies with the cell surface. As a result of initial studies showing that exosomes display signal and immune factors,a particular interest has emerged in their use as a cellular vehicles for stimulation of immune responses in vivo.In recent years,on the base of the knowledge of the biological properties and functions, exosomes have been rebuilt and bound to different kinds of immunological stimulators as a result to enhanced antitumor funotions.In this paper,the related methods,immunological stimulators and the properties of man-made exosomes are mainly reviewed.

Synergic effects of bexarotene and TRAIL on apoptosis of leukemic cell line KG1a / 上海交通大学学报（医学版）

Objective To explore the effects and mechanism of bexarotene in combination with tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) on apoptosis of leukemic cell line KG1a. Methods KG1a cells at logarithmic growth phase were obtained, and were divided into TRAIL group, bexarotene group, 300 ng/mL TRAIL in combination with bexarotene group and 2.0 μmol/L bexaroten in combination with TRAIL group. Cell apoptosis rate was detected in each group by flow cytometry. Flow cytometry was also employed to determine the apoptosis rates of KG1a cells after treatment with bexarotene and TRAIL in different sequences. The expression of Fas associated death domain-like IL-1 beta converting enzyme inhibitory protein (c-FLIP) was detected by Western blotting. Results There was no significant difference in cell apoptosis rates between TRAIL group and bexarotene group of each concentration (except for bexarotene 2.0 μmol/L) (P > 0.05). The cell apoptosis rates of 300 ng/mL TRAIL in combination with bexarotene group and 2.0 μmol/L bexaroten in combination with TRAIL group were significantly higher than those in TRAIL group and bexarotene group of each corresponding concentration (P <0.01). Sequential analysis revealed that bexarotene could reverse the resistance of KG1a cells to TRAIL (P < 0.001). Compared with single use of 2.0 μmol/L bexarotene or 300 ng/mL TRAIL, combination use could significantly down-regulated the expression of c-FLIP (P < 0.05). Conclusion Bexarotene can significantly enhance the apoptosis of KG1a cells induced by TRAIL, which may be attributed to the down-regulation of c-FLIP expression.

Induction chemotherapy with low-dose homoharringtonine, cytarabine, and granulocyte colony-stimulating factor priming in patients with advanced myelodysplastic syndrome or post-myelody splastic syndrome acute myeloid leukemia / 中国医师进修杂志

20?10~9/L. This regimen was given for one course for induction, and was followed by conventional chemotherapy as maintenance or consolidation when complete remission(CR) achieved, or succeeding with other treatment when no response could be observed. Results Six patients achieved CR (54.5%) and one achieved partial remission (PR)(9.1%) with one course of treatment. Among 6 of 11 patients with CR, 5 relapsed at 2,3,6,8 and 16 months respectively. Three relapsed patients were retreated with the same protocol but achieved only one partial responses. Nine of the 11 patients had been died and their mean survival (since induction chemotherapy) was 9.2 months. Infectious complications during cytopenia were less serious than conventional chemotherapy withno treatment-related.Conclusion This moderate intensity protocol with G-CSF priming is effective and safe but remissions are of short duration.

Study on apoptosis in myelodysplastic syndromes by DNA in situ end labelling combined with APAAP / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the total in situ apoptotic cell number and the apoptotic situation in erythroid cell and megakaryocytes in patients with myelodysplastic syndromes (MDS).</p><p><b>METHODS</b>Apoptosis cell number and the apoptotic situation of erythroid cell and megakaryocytes were analysed on cold embedded bone marrow sections from 25 MDS patients by DNA in situ end labelling (ISEL)/alkaline phosphatase anti-alkaline phosphatase (APAAP) double stained techniques. Fourteen cases of iron deficiency anemia (IDA) were taken as control.</p><p><b>RESULTS</b>Mean apoptotic cell numbers in MDS and control group were (39.44 +/- 29.34)/mm(2) and (13.43 +/- 8.39)/mm(2) respectively (P < 0.01). RA/RAS subtypes had a higher apoptosis ratio (47.56 +/- 32.86/mm(2)) than that in RAEB/RAEB-t subtypes (21.87 +/- 13.65/mm(2)) (P < 0.05). Double staining showed similar apoptosis percentage in erythroid cell and megakaryocytes in MDS patients comparing with that of controls (P > 0.05). Some apoptotic cells showing erythroid or megakaryocytic morphologic characteristics expressed no cluster differentiation antigen.</p><p><b>CONCLUSION</b>Overapoptosis existed in MDS, RA/RAS group had a higher apoptosis ratio than RAEB/RAEB-t group. No obvious increased apoptosis in erythroid cell and megakaryocytes was observed in MDS perhaps due to the loss of surface antigens in later stages of apoptotic cells.</p>