Immunophenotyping in Myelodysplastic Syndromes Can Add Prognostic Information to Well-Established and New Clinical Scores

Abstract

Backgroundmyelodysplastic 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.MethodsIn 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.Resultsmedian 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.ConclusionsImmunophenotypic 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.

Flow cytometry “Ogata score” for the diagnosis of myelodysplastic syndromes in a real‐life setting. A Latin American experience

“…Bone marrow multiparametric FC gives complementary information for both MDS diagnosis and prognosis, and it has been introduced as an important co‐criteria for MDS diagnosis . To date, FC in MDS still requires a high level of expertise to analyze and interpret the results, making their daily use in the clinical work‐up of MDS diagnosis difficult .…”

MDS prognostic scoring systems – Past, present, and future

“…Online calculators have been developed to help apply the IPSS-R (http://www.ipss-r.com and http://www.mds-foundation.org/calculator/advanced). The model has been validated by several groups and was extended to and validated in treated patients and at times other than at diagnosis (31-37). Furthermore, the IPSS-R was shown to be an improvement over the IPSS as a classification method for predicting outcomes after standard or reduced-intensity allogeneic haematopoietic cell transplant (38).…”

“…The FCM-score was shown to be both sensitive and specific for diagnosis of the often difficult to diagnose low-grade MDS cases and provided additive prognostic power to the IPSS-R (47, 48). Another study showed that the number of CD34+/CD13+ cells added prognostic value to the IPSS-R (37). To date, none of the major prognostic scoring systems have included flow cytometry variables including lineage infidelity and aberrant antigen expression.…”

Comparison of Myelodysplastic Syndrome Prognostic Scoring Systems

“…Voso et al compared the IPSS, WPSS, and IPSS-R in their IPSS-R validation study and found that the IPSS-R predicted OS better than the other systems [15]. Reis-Alves et al showed that only IPSS-R score was an independent risk factor in terms of OS in their comparison of the IPSS, WPSS, and IPSS-R [16]. …”