Prognostic relevance of lymphocytopenia, monocytopenia and lymphocyte-to-monocyte ratio in primary myelodysplastic syndromes: A single center experience in 889 patients

L. Saeed, Mrinal M Patnaik, Kebede Begna, A. Al-Kali, Mark R Litzow, C. A. Hanson, R. P. Ketterling, L. F. Porrata, Animesh D Pardanani, N. Gangat, Ayalew Tefferi

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Abstract

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.

Original languageEnglish (US)
Article numbere550
JournalBlood Cancer Journal
Volume7
Issue number3
DOIs
StatePublished - Jan 1 2017

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Lymphopenia
Myelodysplastic Syndromes
Monocytes
Lymphocytes
Lymphocyte Count
Immunity
Survival
Leukemia
Therapeutics

ASJC Scopus subject areas

  • Hematology
  • Oncology

Cite this

@article{ecaf199805e2494fbf38175fd401d6f8,
title = "Prognostic relevance of lymphocytopenia, monocytopenia and lymphocyte-to-monocyte ratio in primary myelodysplastic syndromes: A single center experience in 889 patients",
abstract = "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.",
author = "L. Saeed and Patnaik, {Mrinal M} and Kebede Begna and A. Al-Kali and Litzow, {Mark R} and Hanson, {C. A.} and Ketterling, {R. P.} and Porrata, {L. F.} and Pardanani, {Animesh D} and N. Gangat and Ayalew Tefferi",
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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, Mrinal M

AU - Begna, Kebede

AU - Al-Kali, A.

AU - Litzow, Mark R

AU - Hanson, C. A.

AU - Ketterling, R. P.

AU - Porrata, L. F.

AU - Pardanani, Animesh D

AU - Gangat, N.

AU - Tefferi, Ayalew

PY - 2017/1/1

Y1 - 2017/1/1

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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