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Inter-modality variance of blast quantification in patients with myelodysplastic neoplasms (MDS) and its impact on
Laurenz Steiner1, Navkirandeep Kaur1, Johann-Christoph Jann1
1Department of Haematology and Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Abstract:
In the revised International Prognostic Scoring System (IPSS-R), blast enumeration by bone marrow cytology (BM-c) is crucial for risk stratification in myelodysplastic neoplasms (MDS), in the IPSS-Molecular (IPSS-M) however, incorporation of molecular data gained more prognostic impact. Blast count differences in the commonly used methods BM-c, flow cytometry (BM-f) and histology (BM-h) could possibly impact categorisation and overall survival (OS). In n = 145 investigated cases treated since 2012 in our institution, discordance in IPSS-R blast categories was found in 62/145 (43 %) of cases with evaluable blast counts in ≥ 2 methods. Discordant cases scored by BM-c showed either no change (24 %), a downgrade (48 %) or an upgrade (28 %) of their IPSS-R category when applying BM-f or BM-h. Discordant LR-MDS patients had significantly worse OS than concordant (72 vs 35 months, p = 0.031). In contrast, stratification by IPSS-M revealed no OS difference for discordant LR-MDS patients (p = 0.46). We could demonstrate that discordance occurred in almost half of patients, leading to re-stratification in a substantial amount of cases. Furthermore, OS was worse for discordant patients, but differences were ameliorated by inclusion of molecular data. This highlights the growing importance of molecular data over blast quantification in MDS.
Insights
Blast count discrepancies across methods impact myelodysplastic neoplasms (MDS) risk. Molecular data in IPSS-M improved survival prediction, reducing reliance on blast quantification for MDS patients.
Area of Science:
- Hematology
- Oncology
- Molecular Diagnostics
Background:
- The revised International Prognostic Scoring System (IPSS-R) relies on blast enumeration via bone marrow cytology (BM-c) for myelodysplastic neoplasms (MDS) risk stratification.
- The IPSS-Molecular (IPSS-M) incorporates molecular data, potentially offering greater prognostic value.
- Discrepancies in blast counts among bone marrow cytology (BM-c), flow cytometry (BM-f), and histology (BM-h) may affect patient categorization and overall survival (OS).
Purpose of the Study:
- To investigate the impact of blast count discordance between different enumeration methods on IPSS-R categorization and OS in MDS.
- To evaluate whether molecular data integration in IPSS-M mitigates the effect of blast count discordance on OS.
Main Methods:
- Retrospective analysis of 145 MDS cases treated since 2012.
- Comparison of blast counts obtained by BM-c, BM-f, and BM-h.
- Assessment of IPSS-R category re-stratification based on discordant blast counts.
- Survival analysis comparing concordant and discordant cases within IPSS-R and IPSS-M frameworks.
Main Results:
- Discordance in IPSS-R blast categories was observed in 43% of cases evaluated by at least two methods.
- Bone marrow cytology (BM-c) based scoring showed re-categorization in 76% of discordant cases when compared to BM-f or BM-h.
- Discordant lower-risk MDS (LR-MDS) patients had significantly worse OS (72 vs. 35 months, p=0.031) compared to concordant patients based on IPSS-R.
- This OS difference in discordant LR-MDS patients was not significant when stratified by IPSS-M (p=0.46).
Conclusions:
- Blast count discordance between enumeration methods is common in MDS and can lead to significant re-stratification.
- While discordance impacts OS in IPSS-R, the inclusion of molecular data in IPSS-M appears to ameliorate these survival differences.
- Molecular data holds increasing prognostic importance in MDS, potentially surpassing the impact of blast quantification alone.
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