TY - JOUR
T1 - Prognostic relevance of lymphocytopenia, monocytopenia and lymphocyte-to-monocyte ratio in primary myelodysplastic syndromes
T2 - A single center experience in 889 patients
AU - Saeed, L.
AU - Patnaik, M. M.
AU - Begna, K. H.
AU - Al-Kali, A.
AU - Litzow, M. R.
AU - Hanson, C. A.
AU - Ketterling, R. P.
AU - Porrata, L. F.
AU - Pardanani, A.
AU - Gangat, N.
AU - Tefferi, A.
N1 - Publisher Copyright:
© 2017 the American College of Gastroenterology.
PY - 2017
Y1 - 2017
N2 - Current prognostic models for myelodysplastic syndromes (MDS), including the Revised International Prognostic Scoring System (IPSS-R), do not account for host immunity. We retrospectively examined the prognostic relevance of monocytopenia, lymphocytopenia and lymphocyte-to-monocyte ratio (LMR) in a cohort of 889 patients with primary MDS. After a median follow-up of 27 months, 712 (80%) deaths and 116 (13%) leukemic transformation were documented. In univariate analysis, subnormal absolute lymphocyte count (ALC) o0.9 × 109/l; P = 0.001), ALCo1.2 × 109/l (P = 0.0002), subnormal absolute monocyte count (AMC) o0.3 × 109/l (P = 0.0003), LMR (P -0.0001) and LMR5 (P = 0.03) were all associated with inferior overall survival. In multivariable analysis that included other risk factors, significance was retained for LMR (P = 0.02) and became borderline for ALC o1.2 × 109/l (P = 0.06). Analysis in the context of IPSS-R resulted in P-values of 0.06 for ALCo1.2 × 109/l, 0.7 for monocytopenia and 0.2 for LMR. Leukemia-free survival was not affected by ALC, AMC or LMR. The observations from the current study suggest a possible detrimental role for altered host immunity in primary MDS, which might partly explain the therapeutic benefit of immunedirected therapy, including the use of immune modulators; however, IPSS-R-independent prognostic value for either ALC or AMC was limited.
AB - Current prognostic models for myelodysplastic syndromes (MDS), including the Revised International Prognostic Scoring System (IPSS-R), do not account for host immunity. We retrospectively examined the prognostic relevance of monocytopenia, lymphocytopenia and lymphocyte-to-monocyte ratio (LMR) in a cohort of 889 patients with primary MDS. After a median follow-up of 27 months, 712 (80%) deaths and 116 (13%) leukemic transformation were documented. In univariate analysis, subnormal absolute lymphocyte count (ALC) o0.9 × 109/l; P = 0.001), ALCo1.2 × 109/l (P = 0.0002), subnormal absolute monocyte count (AMC) o0.3 × 109/l (P = 0.0003), LMR (P -0.0001) and LMR5 (P = 0.03) were all associated with inferior overall survival. In multivariable analysis that included other risk factors, significance was retained for LMR (P = 0.02) and became borderline for ALC o1.2 × 109/l (P = 0.06). Analysis in the context of IPSS-R resulted in P-values of 0.06 for ALCo1.2 × 109/l, 0.7 for monocytopenia and 0.2 for LMR. Leukemia-free survival was not affected by ALC, AMC or LMR. The observations from the current study suggest a possible detrimental role for altered host immunity in primary MDS, which might partly explain the therapeutic benefit of immunedirected therapy, including the use of immune modulators; however, IPSS-R-independent prognostic value for either ALC or AMC was limited.
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U2 - 10.1038/bcj.2017.30
DO - 10.1038/bcj.2017.30
M3 - Article
C2 - 28362440
AN - SCOPUS:85037574015
SN - 2044-5385
VL - 7
JO - Blood cancer journal
JF - Blood cancer journal
IS - 3
M1 - e550
ER -