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Distinct clinical and experimental characteristics in the patients younger than 60 years old with myelodysplastic syndromes.

Li X, Xiao ZJ, Chang CK, Xu F, Wu LY, He Q, Xu ZF, Song LX, Zhang Z, Zhou LY, Su JY, Zhang X, Guo J - PLoS ONE (2013)

Bottom Line: However, MDS is commonly found in young individuals (<60 years) in Asia.Obvious amplification of T cells and low CFU formation could be found in the younger patients.CFU formation was significantly increased in the younger patients after the removal of activated T cells.

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology, The Sixth Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China. lixiao3326@yahoo.com.cn

ABSTRACT
Myelodysplastic syndromes (MDS) mainly occur in elderly individuals in Western countries. However, MDS is commonly found in young individuals (<60 years) in Asia. The reason for the high incidence in younger individuals is still unclear, and the differences in disease features between young and elderly patients with MDS have been not well recognized. To explore these issues, in this study, we analyzed the clinical and experimental characteristics of MDS in the patients younger and older than 60 years old and characterized the potential age-associated differences. The results showed that over half of the patients with MDS (61.9%) were younger than 60 years old upon the first diagnosis. The younger patients were more likely to be female, who have lower risk and less advanced MDS. The occurrence of trisomy 8 and bone marrow failure were more frequent in the younger patients than the older ones. The marrow CD34+ cells in the younger patients showed lower proliferation and higher apoptosis in comparison with that in the older ones. Obvious amplification of T cells and low CFU formation could be found in the younger patients. CFU formation was significantly increased in the younger patients after the removal of activated T cells. In addition, the younger patients had a lower frequency of p15(INK4B) methylation, longer survival expectancy and less AML transformation. In summary, the younger patients with MDS in China may show more benign disease features than the older ones. Enhanced immunological response may be involved in the pathogenesis of MDS in the patients younger than 60 years.

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Comparison of survival analysis between the younger patients and the older ones with MDS.The younger patients showed significantly longer overall survival (OS) than the older ones (P<0.001) (A). According to WHO classification, the younger patients with less advanced MDS had significantly longer OS than the older ones with less advanced MDS (P<0.001) (B); the younger patients with advanced MDS also showed significantly longer OS than the older ones (P = 0.043) (C). According to IPSS grouping, the younger patients with lower-risk showed significantly longer OS than the older ones with lower-risk (P<0.001) (D); the younger patients with higher-risk also showed significantly longer OS than the older ones (P = 0.021) (E). According to karyotype prognosis scoring, the younger patients with good karyotype showed significantly longer OS than the older ones (P<0.001) (F); Similarly, the younger patients with intermediate-risk karyotype showed significantly longer OS than the older ones (P<0.001) (G). However, there is no difference in OS between the younger patients and the older ones with poor karyotype (P = 0.321) (H).
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pone-0057392-g003: Comparison of survival analysis between the younger patients and the older ones with MDS.The younger patients showed significantly longer overall survival (OS) than the older ones (P<0.001) (A). According to WHO classification, the younger patients with less advanced MDS had significantly longer OS than the older ones with less advanced MDS (P<0.001) (B); the younger patients with advanced MDS also showed significantly longer OS than the older ones (P = 0.043) (C). According to IPSS grouping, the younger patients with lower-risk showed significantly longer OS than the older ones with lower-risk (P<0.001) (D); the younger patients with higher-risk also showed significantly longer OS than the older ones (P = 0.021) (E). According to karyotype prognosis scoring, the younger patients with good karyotype showed significantly longer OS than the older ones (P<0.001) (F); Similarly, the younger patients with intermediate-risk karyotype showed significantly longer OS than the older ones (P<0.001) (G). However, there is no difference in OS between the younger patients and the older ones with poor karyotype (P = 0.321) (H).

Mentions: The median OS was not reached in both groups. However, the younger patients showed significantly longer OS than the older ones (P<0.001), and the probability for survival at 48 months was 73.8% and 34.3% respectively in the younger group and the older one (Figure 3A). The life expectancy of the younger and the older patients were compared in accordance with different risk groups such as WHO classification, IPSS and karyotype prognosis grouping. According to WHO classification, the younger patients with less advanced MDS had significantly longer OS (median OS not reached) than the older ones with less advanced MDS (median OS not reached) (P<0.001) (Figure 3B). Similarly, the younger patients with advanced MDS also showed significantly longer OS than the older ones (median OS: 19 VS 16 months) (P = 0.043) (Figure 3C). According to IPSS grouping, the younger patients with lower-risk showed significantly longer OS (median OS not reached) than the older ones with lower-risk (median OS is 20 months) (P<0.001) (Figure 3D). The younger patients with higher-risk also showed significantly longer OS than the older ones (median OS: 19 VS 12 months) (P = 0.021) (Figure 3E). According to karyotype prognosis scoring, the younger patients with low-risk karyotype showed significantly longer OS (median OS not reached) than the older ones with low-risk karyotype (median OS is 28 months) (P<0.001) (Figure 3F). The younger patients with intermediate-risk karyotype showed significantly longer OS (median OS not reached) than the older ones (median OS is 10 months) (P<0.001) (Figure 3G). However, there is no difference in OS between the younger patients and the older ones with high-risk karyotype (median OS: 20 VS 13 months) (P = 0.321) (Figure 3H).


Distinct clinical and experimental characteristics in the patients younger than 60 years old with myelodysplastic syndromes.

Li X, Xiao ZJ, Chang CK, Xu F, Wu LY, He Q, Xu ZF, Song LX, Zhang Z, Zhou LY, Su JY, Zhang X, Guo J - PLoS ONE (2013)

Comparison of survival analysis between the younger patients and the older ones with MDS.The younger patients showed significantly longer overall survival (OS) than the older ones (P<0.001) (A). According to WHO classification, the younger patients with less advanced MDS had significantly longer OS than the older ones with less advanced MDS (P<0.001) (B); the younger patients with advanced MDS also showed significantly longer OS than the older ones (P = 0.043) (C). According to IPSS grouping, the younger patients with lower-risk showed significantly longer OS than the older ones with lower-risk (P<0.001) (D); the younger patients with higher-risk also showed significantly longer OS than the older ones (P = 0.021) (E). According to karyotype prognosis scoring, the younger patients with good karyotype showed significantly longer OS than the older ones (P<0.001) (F); Similarly, the younger patients with intermediate-risk karyotype showed significantly longer OS than the older ones (P<0.001) (G). However, there is no difference in OS between the younger patients and the older ones with poor karyotype (P = 0.321) (H).
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Related In: Results  -  Collection

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pone-0057392-g003: Comparison of survival analysis between the younger patients and the older ones with MDS.The younger patients showed significantly longer overall survival (OS) than the older ones (P<0.001) (A). According to WHO classification, the younger patients with less advanced MDS had significantly longer OS than the older ones with less advanced MDS (P<0.001) (B); the younger patients with advanced MDS also showed significantly longer OS than the older ones (P = 0.043) (C). According to IPSS grouping, the younger patients with lower-risk showed significantly longer OS than the older ones with lower-risk (P<0.001) (D); the younger patients with higher-risk also showed significantly longer OS than the older ones (P = 0.021) (E). According to karyotype prognosis scoring, the younger patients with good karyotype showed significantly longer OS than the older ones (P<0.001) (F); Similarly, the younger patients with intermediate-risk karyotype showed significantly longer OS than the older ones (P<0.001) (G). However, there is no difference in OS between the younger patients and the older ones with poor karyotype (P = 0.321) (H).
Mentions: The median OS was not reached in both groups. However, the younger patients showed significantly longer OS than the older ones (P<0.001), and the probability for survival at 48 months was 73.8% and 34.3% respectively in the younger group and the older one (Figure 3A). The life expectancy of the younger and the older patients were compared in accordance with different risk groups such as WHO classification, IPSS and karyotype prognosis grouping. According to WHO classification, the younger patients with less advanced MDS had significantly longer OS (median OS not reached) than the older ones with less advanced MDS (median OS not reached) (P<0.001) (Figure 3B). Similarly, the younger patients with advanced MDS also showed significantly longer OS than the older ones (median OS: 19 VS 16 months) (P = 0.043) (Figure 3C). According to IPSS grouping, the younger patients with lower-risk showed significantly longer OS (median OS not reached) than the older ones with lower-risk (median OS is 20 months) (P<0.001) (Figure 3D). The younger patients with higher-risk also showed significantly longer OS than the older ones (median OS: 19 VS 12 months) (P = 0.021) (Figure 3E). According to karyotype prognosis scoring, the younger patients with low-risk karyotype showed significantly longer OS (median OS not reached) than the older ones with low-risk karyotype (median OS is 28 months) (P<0.001) (Figure 3F). The younger patients with intermediate-risk karyotype showed significantly longer OS (median OS not reached) than the older ones (median OS is 10 months) (P<0.001) (Figure 3G). However, there is no difference in OS between the younger patients and the older ones with high-risk karyotype (median OS: 20 VS 13 months) (P = 0.321) (Figure 3H).

Bottom Line: However, MDS is commonly found in young individuals (<60 years) in Asia.Obvious amplification of T cells and low CFU formation could be found in the younger patients.CFU formation was significantly increased in the younger patients after the removal of activated T cells.

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology, The Sixth Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China. lixiao3326@yahoo.com.cn

ABSTRACT
Myelodysplastic syndromes (MDS) mainly occur in elderly individuals in Western countries. However, MDS is commonly found in young individuals (<60 years) in Asia. The reason for the high incidence in younger individuals is still unclear, and the differences in disease features between young and elderly patients with MDS have been not well recognized. To explore these issues, in this study, we analyzed the clinical and experimental characteristics of MDS in the patients younger and older than 60 years old and characterized the potential age-associated differences. The results showed that over half of the patients with MDS (61.9%) were younger than 60 years old upon the first diagnosis. The younger patients were more likely to be female, who have lower risk and less advanced MDS. The occurrence of trisomy 8 and bone marrow failure were more frequent in the younger patients than the older ones. The marrow CD34+ cells in the younger patients showed lower proliferation and higher apoptosis in comparison with that in the older ones. Obvious amplification of T cells and low CFU formation could be found in the younger patients. CFU formation was significantly increased in the younger patients after the removal of activated T cells. In addition, the younger patients had a lower frequency of p15(INK4B) methylation, longer survival expectancy and less AML transformation. In summary, the younger patients with MDS in China may show more benign disease features than the older ones. Enhanced immunological response may be involved in the pathogenesis of MDS in the patients younger than 60 years.

Show MeSH
Related in: MedlinePlus