Telomere length as a prognostic biomarker in myelodysplastic syndrome treated with hypomethylating agents

Telomere length serves as a prognostic factor in hematologic diseases. However, its role in myelodysplastic syndrome (MDS) is unclear. We investigated the prognostic role of telomere length in 71 MDS patients receiving hypomethylating agents (HMAs), using bone marrow samples stored at the Asan Bio-Resource Center. Longer telomere length (median >0.94 kb) before HMA treatment was the only indicator predicting a better overall response rate (ORR) and prolonged progression-free survival (PFS) (ORR = 38.2% vs. 61.8%; odds ratio 2.654, p = 0.046; 1-year PFS, 37.4% vs. 65.6%; hazard ratio 2.356, p = 0.044). However, telomere length showed no association with overall survival (OS), whereas younger age (≤60 years) and allogeneic stem cell transplantation were linked to better OS. No significant differences in telomere length before and during HMA treatment were found. Telomere length may serve as a prognostic biomarker in patients with MDS receiving HMA chemotherapy.