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. © 2013 Reis-Alves et al.
Reis-Alves, S. C., Traina, F., Harada, G., Campos, P. M., Saad, S. T. O., Metze, K., & Lorand-Metze, I. (2013). Immunophenotyping in myelodysplastic syndromes can add prognostic information to well-established and new clinical scores. PLoS ONE, 8(12). https://doi.org/10.1371/journal.pone.0081048