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Prognostic Implication of the Percentage of Erythroid Cells in Bone Marrow at Diagnosis in Patients with Myelodysplastic Syndrome
Poster Presentations – 14th International Symposium on Myelodysplastic Syndromes / Leukemia Research 55 S1 (2017) S45–S167
Conclusions: A proposed prognostic score system from patients with intermediate IPSS-R, allow us to establish a better prognosis stratification in this MDS population. We will validate these results with the French group at the meeting.
262 PROGNOSTIC IMPLICATION OF THE PERCENTAGE OF ERYTHROID CELLS IN BONE MARROW AT DIAGNOSIS IN PATIENTS WITH MYELODYSPLASTIC SYNDROME L. Senent1, I. Lorenzo1, A. Vicente1, E. Alonso2, C. Sanzo3, F. Ramos4, L. Arenillas5, M. Orero6, B. Navarro7, V. Marco9, M. Díez Campelo10, A. Jérez11, J. Montoro12, B. Arrizabalaga13, S. Bonanad1, R. Lluch14, R.D. Paz15, P. Font16, F. Gomis11, G. Sanz1 1 Hematology Department, Hospital Universitari i Politec̀ nic La Fe, Valencia, Spain; 2Pathology Department, Hospital Universitari de Bellvitge, Barcelona, Spain; 3Hospital Universitario Central Asturias, Oviedo, Spain; 4Hospital Universitario de León, León, Spain; 5 Hematological Cytology Laboratory, Hospital del Mar, GRETNHE, IMIM (Hospital del Mar Research Institute), Barcelona, Spain; 6 Hospital General Universitario de Valencia, Spain; 7Hospital Clínico Universitario de Valencia, Spain; 9Hospital Arnau de Vilanova, Lleida, Spain; 10IBSAL, Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain; 11Hematology and Medical Oncology Department, Hospital Morales Meseguer. Centro Regional de Hemodonación. Universidad de Murcia. IMIB, MURCIA, Spain; 12 Hospital Vall D Hebron, Barcelona, Spain; 13Hospital Cruces, Baracaldo, Spain; 14Hospital La Ribera, Alzira, Spain; 15Hospital Universitario La paz, Madrid, Spain; 16Hospital Universitario Gregorio Marañón, Madrid, Spain Introduction: Inclusion of erythroid precursors when counting bone marrow (BM) blasts in MDS remains controversial. Furthermore, the prognostic relevance of erythroid precursors percentage and its relationship with other clinic-biological characteristics is largely unknown. Aims: Analyze the biological and clinical features of MDS patients according to the percentage of erythroid precursors in BM at the time of diagnosis and evaluate its prognostic value on survival.
S151
Methods: We retrospectively analyzed 6,621 of de novo MDS patients from the MDS Spanish registry. All patients were diagnosed according to 2008 WHO criteria. Secondary MDS, chronic myelomonocytic leukemia or unclassified myelodysplastic/myeloproliferative neoplasms were excluded. They were grouped into three groups, according to the percentage of erythroid precursors in BM: less than 15%, between 15% and 49% and more than 50%. Survival curves were constructed by the Kaplan-Meier method and compared using the log-rank test. Multivariable analysis was performed by using Cox proportional hazards regression method. Results: Mean age was 73 y (19–101) and 58% were males. Seven hundred and forty-five patients (11%) showed <15% of the erythroid precursors, 4,910 patients (74%) showed between 15% and 49% and 966 patients (15%) showed ≥50% erythroid precursors. Patients with <15% of erytrhoid precursors had a significantly greater number of cytopenias, a higher percentage of MDS subtypes with excess blasts, higher percentage of blasts cells in blood and BM, and were more frequently stratified in the intermediate and high risk IPSS-R categories (Table 1). The median overall survival (OS) of the whole series was 52 months (95%CI: 49–54). Patients with <15%erytroid precursors in BM experienced a significantly shorter OS (median 26 months) in both univariable (P < 0.0001) and multivariable analysis (P < 0.0001) (Table 2 and Figure 1). Conclusions: This study demonstrates that the presence of <15% erythroid precursors in BM at diagnosis in patients with MDS is associated with lower survival. Thus, enumerating the percentage of erytroid precursors in BM constitutes and easy, quick an inexpensive parameter to refine the prognosis of patients with MDS.
S152
Poster Presentations – 14th International Symposium on Myelodysplastic Syndromes / Leukemia Research 55 S1 (2017) S45–S167
Background: Besides an expansion of myelo-monocytic cells, some patients with CMML show an additional lymphoid proliferation. The neutrophil/lymphocyte ratio (NLR) and monocyte/lymphocyte ratio (MLR) reflect both systemic inflammation and immunosuppression and have emerged as prognostic tools in a variety of diseases, including solid tumors and lymphoma. Little is known about the prognostic impact of these factors in CMML. Methods: The Düsseldorf MDS-registry was screened for patients with a diagnosis of CMML with a complete differential blood count at diagnosis. Patients having received allografting were excluded. The influence of the absolute lymphocyte count (ALC), NLR [ = absolute neutrophil count/ALC] and MLR (absolute monocyte count ALC] at diagnosis and their influence on overall survival were determined by Kaplan-Meier analysis. Multivariable Cox regression analyses were performed. Results: 332 patients (CMML-1 n = 269, CMML-2 n = 63; myeloproliferative or myelodysplastic CMML n = 163 and n = 169) with a median follow up of 17 months (mo) were identified. The alternative CPSS (aCPSS) could be calculated in 127 patients. The medians of ALC, MLR and NLR were 2.2 G/L, 1.2 and 2.5 for all patients, 3.5 G/L, 1.5 and 3.7 for the myeloproliferative and 1.6 G/L, 1.0 and 1.4 for the dysplastic subgroup. 80/332 patients (15%) showed a lymphocytosis (ALC >4.0 G/L), which was much more common in the myeloproliferative than in the myelodysplastic subtype (42% versus 5.9%). Lymphocytopenia (ALC <1.0 G/L) was observed in 44/332 patients (13%) and was more common in the myelodysplastic than in the myeloproliferative subtype (23% versus 2%). By univariate analyses, lymphocytopenia was not associated with overall survival, whereas an ALC >2.5 G/L was associated with significantly shorter survial (median 10 versus 26 mo, p < 0.001), as were a NLR <4 (median OS 27 versus 16 mo, p = 0.005) and MLR <1.2 (median OS 30 mo versus 17, p = 0.003). In multivariable analyses, ALC >2.5 G/L retained its independent prognostic value after adjustment for LDH (>ULN 240U/L), monocytosis (>5 G/L) and the WHO2008 classification, but there was no additional prognostic value if the aCPSS-strata were included into the Cox regression models. NLR and MLR showed no additional prognostic value in either of the performed multivable analyses. Conclusion: Our data reveal a high prevalence of lymphocytosis in patients with the myeloproliferative form of CMML and demonstrate the prognostic significance of the absolute lymphocyte count in this disease. Further work is needed to characterize the lymphocyte subpopulations contributing to lymphocytosis in CMML and to define its biological basis.
263 LYMPHOCYTOSIS, NEUTROPHIL/LYMPHOCYTE RATIO AND MONOCYTE/LYMPHOCYTE RATIO AS PROGNOSTIC MARKERS IN CMML T. Silzle1, E. Schuler2, B. Hildebrandt3, R. Haas2, A. Templeton4, U. Germing2 1 Oncology/Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; 2Department of Haematology- Oncology and Clinical Immunology, Düsseldorf University Hospital, Düsseldorf, Germany; 3 Düsseldorf University Hospital, Institute of Human Genetics, Düsseldorf, Germany; 4Claraspital, Oncology/Haematology, Basel, Switzerland
264 SERUM ALBUMIN LEVEL AT DIAGNOSIS MAY PROVIDE ADDITIONAL PROGNOSTIC INFORMATION IN PATIENTS WITH MYELODYSPLASTIC SYNDROMES B. Spassov1, M. Jagurinoski2, S. Angelova3, G. Mihaylov1, G. Balatzenko3, M. Guenova2 1 Department of Clinical Hematology, Specialized Hospital for Active Therapy of Hematological Diseases, Sofia, Bulgaria; 2Specialized Hospital for Active Therapy of Hematological Diseases, Laboratory of Hematopathology & Immunology, Sofia, Bulgaria; 3Specialized Hospital for Active Therapy of Hematological Diseases, Laboratory of Cytogenetics & Molecular Biology, Sofia, Bulgaria Background: Revised International Prognostic Scoring System (IPSS-R) is the most commonly used tool for prognostic stratification of myelodysplastic syndromes (MDS) patients ( pts), identifying 5 distinct [Very low (VL), Low (L), Intermediate (I), high (H) and very high (VH)] risk groups (RGs). Inflammatory and immune responses in tumor microenvironment seems be important in
Conclusions: A proposed prognostic score system from patients with intermediate IPSS-R, allow us to establish a better prognosis stratification in this MDS population. We will validate these results with the French group at the meeting.
262 PROGNOSTIC IMPLICATION OF THE PERCENTAGE OF ERYTHROID CELLS IN BONE MARROW AT DIAGNOSIS IN PATIENTS WITH MYELODYSPLASTIC SYNDROME L. Senent1, I. Lorenzo1, A. Vicente1, E. Alonso2, C. Sanzo3, F. Ramos4, L. Arenillas5, M. Orero6, B. Navarro7, V. Marco9, M. Díez Campelo10, A. Jérez11, J. Montoro12, B. Arrizabalaga13, S. Bonanad1, R. Lluch14, R.D. Paz15, P. Font16, F. Gomis11, G. Sanz1 1 Hematology Department, Hospital Universitari i Politec̀ nic La Fe, Valencia, Spain; 2Pathology Department, Hospital Universitari de Bellvitge, Barcelona, Spain; 3Hospital Universitario Central Asturias, Oviedo, Spain; 4Hospital Universitario de León, León, Spain; 5 Hematological Cytology Laboratory, Hospital del Mar, GRETNHE, IMIM (Hospital del Mar Research Institute), Barcelona, Spain; 6 Hospital General Universitario de Valencia, Spain; 7Hospital Clínico Universitario de Valencia, Spain; 9Hospital Arnau de Vilanova, Lleida, Spain; 10IBSAL, Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain; 11Hematology and Medical Oncology Department, Hospital Morales Meseguer. Centro Regional de Hemodonación. Universidad de Murcia. IMIB, MURCIA, Spain; 12 Hospital Vall D Hebron, Barcelona, Spain; 13Hospital Cruces, Baracaldo, Spain; 14Hospital La Ribera, Alzira, Spain; 15Hospital Universitario La paz, Madrid, Spain; 16Hospital Universitario Gregorio Marañón, Madrid, Spain Introduction: Inclusion of erythroid precursors when counting bone marrow (BM) blasts in MDS remains controversial. Furthermore, the prognostic relevance of erythroid precursors percentage and its relationship with other clinic-biological characteristics is largely unknown. Aims: Analyze the biological and clinical features of MDS patients according to the percentage of erythroid precursors in BM at the time of diagnosis and evaluate its prognostic value on survival.
S151
Methods: We retrospectively analyzed 6,621 of de novo MDS patients from the MDS Spanish registry. All patients were diagnosed according to 2008 WHO criteria. Secondary MDS, chronic myelomonocytic leukemia or unclassified myelodysplastic/myeloproliferative neoplasms were excluded. They were grouped into three groups, according to the percentage of erythroid precursors in BM: less than 15%, between 15% and 49% and more than 50%. Survival curves were constructed by the Kaplan-Meier method and compared using the log-rank test. Multivariable analysis was performed by using Cox proportional hazards regression method. Results: Mean age was 73 y (19–101) and 58% were males. Seven hundred and forty-five patients (11%) showed <15% of the erythroid precursors, 4,910 patients (74%) showed between 15% and 49% and 966 patients (15%) showed ≥50% erythroid precursors. Patients with <15% of erytrhoid precursors had a significantly greater number of cytopenias, a higher percentage of MDS subtypes with excess blasts, higher percentage of blasts cells in blood and BM, and were more frequently stratified in the intermediate and high risk IPSS-R categories (Table 1). The median overall survival (OS) of the whole series was 52 months (95%CI: 49–54). Patients with <15%erytroid precursors in BM experienced a significantly shorter OS (median 26 months) in both univariable (P < 0.0001) and multivariable analysis (P < 0.0001) (Table 2 and Figure 1). Conclusions: This study demonstrates that the presence of <15% erythroid precursors in BM at diagnosis in patients with MDS is associated with lower survival. Thus, enumerating the percentage of erytroid precursors in BM constitutes and easy, quick an inexpensive parameter to refine the prognosis of patients with MDS.
S152
Poster Presentations – 14th International Symposium on Myelodysplastic Syndromes / Leukemia Research 55 S1 (2017) S45–S167
Background: Besides an expansion of myelo-monocytic cells, some patients with CMML show an additional lymphoid proliferation. The neutrophil/lymphocyte ratio (NLR) and monocyte/lymphocyte ratio (MLR) reflect both systemic inflammation and immunosuppression and have emerged as prognostic tools in a variety of diseases, including solid tumors and lymphoma. Little is known about the prognostic impact of these factors in CMML. Methods: The Düsseldorf MDS-registry was screened for patients with a diagnosis of CMML with a complete differential blood count at diagnosis. Patients having received allografting were excluded. The influence of the absolute lymphocyte count (ALC), NLR [ = absolute neutrophil count/ALC] and MLR (absolute monocyte count ALC] at diagnosis and their influence on overall survival were determined by Kaplan-Meier analysis. Multivariable Cox regression analyses were performed. Results: 332 patients (CMML-1 n = 269, CMML-2 n = 63; myeloproliferative or myelodysplastic CMML n = 163 and n = 169) with a median follow up of 17 months (mo) were identified. The alternative CPSS (aCPSS) could be calculated in 127 patients. The medians of ALC, MLR and NLR were 2.2 G/L, 1.2 and 2.5 for all patients, 3.5 G/L, 1.5 and 3.7 for the myeloproliferative and 1.6 G/L, 1.0 and 1.4 for the dysplastic subgroup. 80/332 patients (15%) showed a lymphocytosis (ALC >4.0 G/L), which was much more common in the myeloproliferative than in the myelodysplastic subtype (42% versus 5.9%). Lymphocytopenia (ALC <1.0 G/L) was observed in 44/332 patients (13%) and was more common in the myelodysplastic than in the myeloproliferative subtype (23% versus 2%). By univariate analyses, lymphocytopenia was not associated with overall survival, whereas an ALC >2.5 G/L was associated with significantly shorter survial (median 10 versus 26 mo, p < 0.001), as were a NLR <4 (median OS 27 versus 16 mo, p = 0.005) and MLR <1.2 (median OS 30 mo versus 17, p = 0.003). In multivariable analyses, ALC >2.5 G/L retained its independent prognostic value after adjustment for LDH (>ULN 240U/L), monocytosis (>5 G/L) and the WHO2008 classification, but there was no additional prognostic value if the aCPSS-strata were included into the Cox regression models. NLR and MLR showed no additional prognostic value in either of the performed multivable analyses. Conclusion: Our data reveal a high prevalence of lymphocytosis in patients with the myeloproliferative form of CMML and demonstrate the prognostic significance of the absolute lymphocyte count in this disease. Further work is needed to characterize the lymphocyte subpopulations contributing to lymphocytosis in CMML and to define its biological basis.
263 LYMPHOCYTOSIS, NEUTROPHIL/LYMPHOCYTE RATIO AND MONOCYTE/LYMPHOCYTE RATIO AS PROGNOSTIC MARKERS IN CMML T. Silzle1, E. Schuler2, B. Hildebrandt3, R. Haas2, A. Templeton4, U. Germing2 1 Oncology/Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; 2Department of Haematology- Oncology and Clinical Immunology, Düsseldorf University Hospital, Düsseldorf, Germany; 3 Düsseldorf University Hospital, Institute of Human Genetics, Düsseldorf, Germany; 4Claraspital, Oncology/Haematology, Basel, Switzerland
264 SERUM ALBUMIN LEVEL AT DIAGNOSIS MAY PROVIDE ADDITIONAL PROGNOSTIC INFORMATION IN PATIENTS WITH MYELODYSPLASTIC SYNDROMES B. Spassov1, M. Jagurinoski2, S. Angelova3, G. Mihaylov1, G. Balatzenko3, M. Guenova2 1 Department of Clinical Hematology, Specialized Hospital for Active Therapy of Hematological Diseases, Sofia, Bulgaria; 2Specialized Hospital for Active Therapy of Hematological Diseases, Laboratory of Hematopathology & Immunology, Sofia, Bulgaria; 3Specialized Hospital for Active Therapy of Hematological Diseases, Laboratory of Cytogenetics & Molecular Biology, Sofia, Bulgaria Background: Revised International Prognostic Scoring System (IPSS-R) is the most commonly used tool for prognostic stratification of myelodysplastic syndromes (MDS) patients ( pts), identifying 5 distinct [Very low (VL), Low (L), Intermediate (I), high (H) and very high (VH)] risk groups (RGs). Inflammatory and immune responses in tumor microenvironment seems be important in