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A Prospective, Cross Sectional Study of PNH Clone in MDS Patients Using High Sensitivity Flowcytometry: A Single
Faran Naim1, Amrita Saraf2, Jasmita Dass2
1Department of Clinical Hematology, Sir Ganga Ram Hospital, New Delhi, India.
Abstract:
Subclinical PNH can be present in patients with bone marrow failure like aplastic anemia and myelodysplastic syndrome (MDS). Such clone may have prognostic and therapeutic implications. In literature around 1-10% MDS cases have shown a PNH clone, however, data from India is relatively scarce. A high sensitivity PNH assay was employed using a single tube combination of FLAER, CD157, CD64, CD15 and CD45 antibodies in adult patients of MDS at presentation. A clone size of > 0.01% was taken as significant. A total of 30 patients were included. PNH clone was present in 30% cases. Correlation done between PNH clone size and LDH values showed moderately positive correlation (r = 0.735, p = 0.001, r2 = 0.541). As per this study a LDH cut off of 247 IU is likely to predict a PNH clone (> 1%) with moderate sensitivity and specificity. High sensitivity PNH assay is able to detect small PNH clone. Calculating the cut-off of LDH to predict PNH positivity can help us judiciously prescribe this test in MDS patients in resource constrained settings.
Insights
Subclinical paroxysmal nocturnal hemoglobinuria (PNH) clones are found in 30% of myelodysplastic syndrome (MDS) patients in India. Lactate dehydrogenase (LDH) levels can help predict PNH clone presence in MDS.
Area of Science:
- Hematology
- Oncology
- Clinical Diagnostics
Background:
- Subclinical paroxysmal nocturnal hemoglobinuria (PNH) clones can be present in patients with bone marrow failure syndromes, including aplastic anemia and myelodysplastic syndrome (MDS).
- The presence of a PNH clone in MDS may have significant prognostic and therapeutic implications.
- While literature suggests 1-10% of MDS cases harbor a PNH clone, data from India is limited.
Purpose of the Study:
- To investigate the prevalence of PNH clones in adult MDS patients at presentation in India.
- To evaluate the correlation between PNH clone size and lactate dehydrogenase (LDH) levels.
- To determine a potential LDH cut-off for predicting PNH positivity in MDS patients, aiding test prescription in resource-limited settings.
Main Methods:
- A high-sensitivity PNH assay using a single tube with FLAER, CD157, CD64, CD15, and CD45 antibodies was employed.
- The study included 30 adult patients diagnosed with MDS at presentation.
- A PNH clone size greater than 0.01% was considered significant.
Main Results:
- A PNH clone was detected in 30% of the studied MDS patients.
- A moderately positive correlation (r=0.735, p=0.001) was observed between PNH clone size and LDH values.
- An LDH cut-off of 247 IU/L was identified as a potential predictor of a PNH clone (>1%) with moderate sensitivity and specificity.
Conclusions:
- High-sensitivity PNH assays are effective in detecting even small PNH clones in MDS patients.
- LDH levels show a significant correlation with PNH clone size in MDS.
- Establishing an LDH cut-off can assist in judiciously selecting MDS patients for PNH testing, particularly in resource-constrained environments.
