Bone marrow cells from myelodysplastic syndromes show altered immunophenotypic profiles that may contribute to the diagnosis and prognostic stratification of the disease: A pilot study on a series of 56 patients

Abstract

A heterogeneous spectrum of immunophenotypic abnormalities have been reported in myelodysplastic syndromes (MDS). However, most studies are restricted to the analysis of CD341 cells and/or other major subsets of CD34 2 cells, frequently not exploring the diagnostic and prognostic impact of immunophenotyping.Methods: We propose for the first time an immunophenotypic score (IS) based on the altered distribution and immunophenotypic features of maturing/mature compartments of bone marrow (BM) hematopoietic cells in 56 patients with MDS that could contribute to a refined diagnosis and prognostic evaluation of the disease.Results: Although MDS-associated phenotypes were detected in reactive BM, the overall immunophenotypic profile of BM cells allowed an efficient discrimination between MDS and both normal and reactive BM, once the number and degree of severity of the abnormalities detected per patient were simultaneously considered in the proposed IS. Interestingly, increasingly higher IS were found among patients with MDS showing adverse prognostic factors and in low-versus high-grade cases. The most informative prognostic factors included the number of CD34 1 cells, presence of aberrant CD34 2 /CD117 1 precursors, decreased mature neutrophils and CD34 2 erythroid precursors, and increased numbers of CD36 2/lo erythroid precursors; in addition, the IS was an independent prognostic factor for overall survival.Conclusions: Assessment of immunophenotypic abnormalities of maturing/mature BM cells allows an efficient discrimination between MDS and both normal and reactive BM, once the number and degree of severity of the abnormalities detected are simultaneously scored. Interestingly, progressively higher IS were found among patients with MDS with adverse prognostic features and shorter overall survival.

Standardization of flow cytometry in myelodysplastic syndromes: a report from an international consortium and the European LeukemiaNet Working Group

“…27,28 A decrease in CD38 expression on CD34 þ myeloid progenitor cells has also been reported as a rather typical aberrancy in MDS. 29,30 Analysis of the maturing myeloid and monocytic compartment Definition of neutrophils.…”

“…The endoglin marker CD105 is also used, but data on this particular marker are scarce. 9,22,28,36,56 Some of the aberrancies that are currently considered relevant (Table 1), and their accompanying pitfalls, are discussed here.…”

“…By contrast, a decrease in erythroid progenitors, due to apoptosis or erythropoietin deficiency, can also be observed. 9,22,28,36,56 Moreover, quantification of the amount of erythroid progenitors may be affected by red-cell lysing procedures, which may potentially lyse some of the nucleated red blood cells. It might therefore be worthwhile to analyze the erythroid/myeloid ratio before and after lysis.…”

“…9,22,28,36,56 An example is displayed in Figure 4. It should be kept in mind that the transferrin receptor (CD71) has a role in iron uptake and can also be present on non-erythroid immature cells, as it is required for their metabolism.…”

Evaluation of flow cytometric assessment of myeloid nuclear differentiation antigen expression as a diagnostic marker for myelodysplastic syndromes in a series of 269 patients

“…The value of MFC for making the diagnosis MDS and even in detecting prognostic factors for this disease has been demonstrated in a number of studies (16)(17)(18)(19). Different ''flow scores'' have been introduced for MFC in MDS (20)(21)(22). However, MFC is also not free of subjective weighing, for example, in judging maturation patterns for granulocytes.…”