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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