It is often difficult to distinguish hypoplastic myelodysplastic syndrome (h-MDS) from acquired aplastic anaemia (AA), because of the considerable clinical, cytological and histological similarities between these two disorders. The distinction between AA and h-MDS is important because there is a higher risk of progression to acute leukaemia in patients with h-MDS compared with AA. Recent studies suggest that tumour necrosis factor-alpha (TNF-α) plays an important role in the development of AA. In order to determine the potential importance of TNF-α in the differential diagnosis of hypoplastic bone marrow (BM) disorders, we examined whether analysis of TNF-receptor expression could be used as a tool to differentiate AA from h-MDS. Flow cytometric analysis revealed that BM stem cells (CD34+) from AA patients have markedly greater TNF receptor (R) 1 and TNFR2 expression than those from patients with MDS and h-MDS. We suggest that the BM stem cells with a high expression of TNFR in patients with AA may be potently sensitive to TNF-α stimulation of differentiation. Thus, we propose that quantification of TNFR expression in BM stem cells may be a useful method to distinguish AA from h-MDS.
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