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The prognostic value of circulating myeloblasts in patients with myelodysplastic syndromes
Vu H Duong1, Eric Padron2, Najla H Al Ali2
1University of Maryland School of Medicine and Greenebaum Comprehensive Cancer Center, 22 S. Greene Street, S9D04B, Baltimore, MD, 21201, USA. vduong@umm.edu.
Abstract:
The prognostic value of peripheral blasts (PB) is not well-studied in patients with myelodysplastic syndromes (MDS). We evaluated the impact of PB on overall survival (OS) and transformation to acute myeloid leukemia (AML) in a large cohort. The MDS database at the Moffitt Cancer Center was retrospectively reviewed to identify patients with ≥ 1% PB (PB-MDS) and those without PB (BM-MDS). We also assessed the correlation between PB and gene mutations. One thousand seven hundred fifty-eight patients were identified, among whom 13% had PB near the time of diagnosis. PB-MDS patients were more likely to be younger with trilineage cytopenia, complex karyotype, higher-risk disease, transfusion dependence, and therapy-related MDS. The rate of AML transformation was 49 vs. 26% (p < 0.005) and median OS was 16.5 vs. 45.8 months (p < 0.005) in the PB-MDS and BM-MDS groups, respectively. In Cox regression analysis, the presence of PB was an independent prognostic covariate for OS, HR 1.57 (95% CI 1.2-2). Among 51 patients with an available gene panel, the rate of ≥ 1 gene mutation in the PB-MDS group (n = 4) was 100% compared to 81% in the BM-MDS group (n = 47). The presence of PB in MDS is an adverse independent prognostic variable that refines prognostic discrimination.
Insights
Peripheral blasts (PB) in myelodysplastic syndromes (MDS) indicate a worse prognosis. Patients with PB showed higher rates of acute myeloid leukemia (AML) transformation and shorter overall survival (OS), highlighting PB as a key adverse prognostic factor.
Area of Science:
- Hematology
- Oncology
- Clinical Research
Background:
- The prognostic significance of peripheral blasts (PB) in myelodysplastic syndromes (MDS) remains incompletely understood.
- Accurate prognostic markers are crucial for managing MDS and predicting patient outcomes.
Purpose of the Study:
- To investigate the impact of peripheral blasts (PB) on overall survival (OS) and acute myeloid leukemia (AML) transformation in a large cohort of myelodysplastic syndromes (MDS) patients.
- To assess the correlation between PB and genetic mutations in MDS.
Main Methods:
- Retrospective review of a large MDS patient database (n=1758) from Moffitt Cancer Center.
- Categorization of patients into groups based on the presence (PB-MDS) or absence (BM-MDS) of ≥1% PB at diagnosis.
- Analysis of clinical characteristics, AML transformation rates, OS, and gene mutation profiles.
Main Results:
- 13% of MDS patients exhibited PB at diagnosis.
- PB-MDS patients had significantly higher rates of AML transformation (49% vs. 26%) and shorter median OS (16.5 vs. 45.8 months) compared to BM-MDS patients.
- PB was identified as an independent adverse prognostic factor for OS (HR 1.57).
- PB-MDS patients showed a higher prevalence of gene mutations (100% vs. 81%).
Conclusions:
- The presence of peripheral blasts (PB) in myelodysplastic syndromes (MDS) is an adverse prognostic indicator.
- PB presence refines prognostic discrimination and is associated with poorer outcomes, including increased risk of AML transformation and reduced overall survival.
- PB status should be incorporated into MDS prognostic models.
