Immunophenotyping in myelodysplastic syndromes can add prognostic information to well-established and new clinical scores.

Abstract

BACKGROUND:

myelodysplastic syndromes (MDS) are a heterogeneous group of hematopoietic clonal disorders. So, prognostic variables are important to separate patients with a similar biology and clinical outcome. We compared the importance of risk stratification in primary MDS of IPSS and WPSS with the just described revision of IPSS (IPSS-R), and examined if variables obtained by bone marrow immunophenotyping could add prognostic information to any of the scores.

METHODS:

In this prospective study of 101 cases of primary MDS we compared the relation of patients' overall survival with WHO types, IPSS, IPSS-R, WPSS and phenotypic abnormalities of hematopoietic precursors. We examined aberrancies in myelomonocytic precursors and CD34(+) cells. Patients were censored when receiving chemotherapy or BM transplantation. Survival analysis was made by Cox regressions and stability of the models was examined by bootstrap resampling.

RESULTS:

MEDIAN AGE: 64 years (15-93). WHO types: 2 cases of 5q- syndrome, 7 of RA, 64 of RCDM and 28 of RAEB. In the univariate Cox analysis, increasing risk category of all scores, degree of anemia, higher percentage of BM blasts, higher number of CD34(+) cells and their myeloid fractions besides increasing number of phenotypic abnormalities detected were significantly associated with a shorter survival. In the multivariate analysis comparing the three scores, IPSS-R was the only independent risk factor. Comparing WPSS with phenotypic variables (CD34(+)/CD13(+) cells, CD34(+)/CD13(-) cells and "total alterations") the score and "CD34(+)/CD13(+) cells" remained in the model. When IPSS was tested together with these phenotypic variables, only "CD34(+)/CD13(+) cells", and "total alterations" remained in the model. Testing IPSS-R with the phenotypic variables studied, only the score and "CD34(+)/CD13(+) cells" entered the model.

CONCLUSIONS:

Immunophenotypic analysis of myelomonocytic progenitors provides additional prognostic information to all clinical scores studied. IPSS-R improved risk stratification in MDS compared to the former scores.

• Authors: Suiellen C Reis-Alves, Fabíola Traina, Guilherme Harada, Paula M Campos, Sara T O Saad, Konradin Metze, Irene Lorand-Metze
• Journal: PloS one (PLoS One) Vol. 8 Issue 12 Pg. e81048 ( 2013) ISSN: 1932-6203 [Electronic] United States
• PMID: 24324660 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antigens, CD34
• CD13 Antigens

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antigens, CD34 (immunology)
• Bone Marrow (immunology, pathology)
• Bone Marrow Transplantation
• CD13 Antigens (immunology)
• Female
• Humans
• Immunophenotyping
• Male
• Middle Aged
• Myelodysplastic Syndromes (diagnosis, immunology, mortality, therapy)
• Proportional Hazards Models
• Prospective Studies
• Risk Factors
• Survival Analysis