Prognostic significance of morphology markers of chromosomal instability in acute leukaemia and myelodysplastic syndrome

Objective: This study aimed to assess the prognostic significance of various morphological markers of chromosomal instability (CI).Design: This is a cross-sectional analytical study.Setting: Single centre study from the Department of Pathology of a tertiary care centre in India.Participants: The study included samples of bone marrow aspirates (BMA) and biopsies of patients with acute leukaemia (AL) and myelodysplastic syndrome (MDS) performed between June 2019 and June 2021. Inadequate samples were excluded. We included 178 samples from 80 cases.Interventions: BMA and biopsies slides examined for CI markers like chromatin bridges, multipolar mitosis, nuclear budding, micronuclei, laggards, chromatin string (CS) and nuclear heterogeneity (NH). CI markers were correlated with the type, severity and prognosis of acute leukaemia and MDS.Main outcome measures: Evaluation of CI markers as prognostic markers in AL and MDS.Results: We included B-cell ALL (35), AML (11), MDS (04), relapse of AL (12), and remission of AL (116). All CI markers were significantly increased in AL and MDS compared to the remission group. All CI markers were significantly higher in non-responders to therapy than in responders. In regression analysis, the median (IQR) values of CS and NH were significantly higher among non-survivors than survivors.Conclusion: CI markers of morphology are significantly associated with poor prognosis, including Non-survival of the disease. These markers are easy to identify and cost-effective. We recommend incorporating morphological markers of CI in routine reporting of haematological malignancies to assist in prognostication before reports from sophisticated techniques are available.