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

Author(s)

Reis-Alves, Suiellen C. ^[1] ; Traina, Fabiola ^[1] ; Harada, Guilherme ^[2] ; Campos, Paula M. ^[2] ; Saad, Sara T. O. ^{[2, 1]} ; Metze, Konradin ^[2] ; Lorand-Metze, Irene ^{[2, 1]}

Affiliation

^[1] Univ Estadual Campinas, Hematol & Hemotherapy Ctr, Sao Paulo - Brazil

^[2] Univ Estadual Campinas, Fac Med, Sao Paulo - Brazil

• Document type: Journal article
• Source: PLoS One; v. 8, n. 12 DEC 6 2013.
• Web of Science Citations: 15

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. (AU)