Erythroid hypoplasia among patients with myelodysplastic neoplasms: Erythroid hypoplasia

Anemia is one of the major concerns in the setting of myelodysplastic neoplasms (MDS). The last WHO classification mandates bone marrow trephine evaluation with special focus to fibrosis and cellularity. At variance, erythroid hypoplasia might be disregarded. In this retrospective study, we assessed the prevalence of erythroid hypoplasia within a monocentric cohort of MDS patients within all risk categories. Erythroid hypoplasia was evaluated on both bone marrow aspirate and/or trephine at diagnosis, along with clinical, hematological, molecular data, as well as treatments and outcomes. Our data show that erythroid hypoplasia is present in more than 5% of MDS patients and is often disregarded. Hypoplastic patients showed more severe transfusion dependent anemia, higher levels of endogenous erythropoietin, and shorter duration of response to ESAs. It was showed a lower prevalence of genomic alterations in patients with erythroid hypoplasia vs the others. Moreover, hypoplastic patients were more frequently treated with CyA and had fairly higher response rates than other MDS population. To our knowledge, this finding highlights the importance to consider the morphological characteristics of the erythroid compart that may give hints to an immunomodulating therapeutical approach.