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Establishment and validation of an updated diagnostic FCM scoring system based on pooled immunophenotyping in CD34+ blasts and its clinical significance for myelodysplastic syndromes.

Xu F, Li X, Chang CK, Guo J, Wu LY, He Q, Zhang Z, Zhu Y, Gu SC, Shi WH, Song LX, Su JY, Zhou LY, Zhang X, Wu D - PLoS ONE (2014)

Bottom Line: The results suggested that early scoring from abnormal expression of mature myeloid/lymphoid antigens and advanced scoring from abnormal expression of stem/progenitor antigens expression constituted the majority of FCM scores of low-grade and high-grade MDS, respectively.High early scoring was generally accompanied by low IPSS-R score and superior survival, whereas high advanced scoring was accompanied by high IPSS-R score and inferior survival.In conclusion, the u-FCMSS is a useful tool for diagnosis, prognosis and treatment selection in MDS.

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China ; Department of Internal Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

ABSTRACT
Abnormal immunophenotypes of hematopoietic cells can be detected by flow cytometry (FCM) to assist the diagnosis of myelodysplastic syndromes (MDS). We previously established a FCM scoring system for the diagnosis of low-grade MDS. In this study, additional valuable antigens were involved in an updated FCM scoring system (u-FCMSS) for all MDS subtypes. The u-FCMSS showed better sensitivity and specificity (89.4% and 96.5%) in distinguishing MDS from non-clonal cytopenia diseases. Validation analysis of u-FCMSS exhibited comparable sensitivity and specificity (86.7% and 93.3%) and high agreement rate (88.9%) of FCM diagnosis with morphological diagnosis at optimal cut-off (score 3). The distribution of FCM scores in different disease stages was also analyzed. The results suggested that early scoring from abnormal expression of mature myeloid/lymphoid antigens and advanced scoring from abnormal expression of stem/progenitor antigens expression constituted the majority of FCM scores of low-grade and high-grade MDS, respectively. High early scoring was generally accompanied by low IPSS-R score and superior survival, whereas high advanced scoring was accompanied by high IPSS-R score and inferior survival. In addition, the low-risk MDS patients with high early scoring and low advanced scoring were revealed as candidates for immunosuppressive therapy, whereas those with high advanced scoring and low early scoring may be more suitable for decitabine treatment. In conclusion, the u-FCMSS is a useful tool for diagnosis, prognosis and treatment selection in MDS. Differences in classes of antigens expressed and in distribution of FCM scores may reflect distinctive stage characteristics of MDS during disease progression.

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Related in: MedlinePlus

Distinctive distribution of early and advanced scoring in low-grade and high-grade MDS and the relationship between early and advanced scoring.(A) Early scoring gradually decreased but advanced scoring gradually increased from low-grade MDS with normal karyotype to low-grade MDS with abnormal karyotype then to high-grade MDS. (B) Early scoring showed inversely correlated with advanced scoring (Spearman r = −0.363, P = 0.001).
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pone-0088706-g002: Distinctive distribution of early and advanced scoring in low-grade and high-grade MDS and the relationship between early and advanced scoring.(A) Early scoring gradually decreased but advanced scoring gradually increased from low-grade MDS with normal karyotype to low-grade MDS with abnormal karyotype then to high-grade MDS. (B) Early scoring showed inversely correlated with advanced scoring (Spearman r = −0.363, P = 0.001).

Mentions: FCM scoring from CD34, CD19, CD38, CD117 and CD7 was defined as advanced scoring because these antigens were frequently abnormal in high-grade MDS, and FCM scoring from CD15, CD11b, CD4 and CD56 was defined as early scoring because these antigens were frequently abnormal in low-grade MDS. As shown in Figure 2A, early scoring gradually decreased but advanced scoring gradually increased through the progression from low-grade MDS with normal karyotype to low-grade MDS with abnormal karyotype and then to high-grade MDS (Figure 2A). In addition, early scoring showed an inverse correlation with advanced scoring (Spearman r = −0.421, P<0.001) (Figure 2B). It seemed that MDS patients could not simultaneously score highly in both early and advanced scoring.


Establishment and validation of an updated diagnostic FCM scoring system based on pooled immunophenotyping in CD34+ blasts and its clinical significance for myelodysplastic syndromes.

Xu F, Li X, Chang CK, Guo J, Wu LY, He Q, Zhang Z, Zhu Y, Gu SC, Shi WH, Song LX, Su JY, Zhou LY, Zhang X, Wu D - PLoS ONE (2014)

Distinctive distribution of early and advanced scoring in low-grade and high-grade MDS and the relationship between early and advanced scoring.(A) Early scoring gradually decreased but advanced scoring gradually increased from low-grade MDS with normal karyotype to low-grade MDS with abnormal karyotype then to high-grade MDS. (B) Early scoring showed inversely correlated with advanced scoring (Spearman r = −0.363, P = 0.001).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928275&req=5

pone-0088706-g002: Distinctive distribution of early and advanced scoring in low-grade and high-grade MDS and the relationship between early and advanced scoring.(A) Early scoring gradually decreased but advanced scoring gradually increased from low-grade MDS with normal karyotype to low-grade MDS with abnormal karyotype then to high-grade MDS. (B) Early scoring showed inversely correlated with advanced scoring (Spearman r = −0.363, P = 0.001).
Mentions: FCM scoring from CD34, CD19, CD38, CD117 and CD7 was defined as advanced scoring because these antigens were frequently abnormal in high-grade MDS, and FCM scoring from CD15, CD11b, CD4 and CD56 was defined as early scoring because these antigens were frequently abnormal in low-grade MDS. As shown in Figure 2A, early scoring gradually decreased but advanced scoring gradually increased through the progression from low-grade MDS with normal karyotype to low-grade MDS with abnormal karyotype and then to high-grade MDS (Figure 2A). In addition, early scoring showed an inverse correlation with advanced scoring (Spearman r = −0.421, P<0.001) (Figure 2B). It seemed that MDS patients could not simultaneously score highly in both early and advanced scoring.

Bottom Line: The results suggested that early scoring from abnormal expression of mature myeloid/lymphoid antigens and advanced scoring from abnormal expression of stem/progenitor antigens expression constituted the majority of FCM scores of low-grade and high-grade MDS, respectively.High early scoring was generally accompanied by low IPSS-R score and superior survival, whereas high advanced scoring was accompanied by high IPSS-R score and inferior survival.In conclusion, the u-FCMSS is a useful tool for diagnosis, prognosis and treatment selection in MDS.

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China ; Department of Internal Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

ABSTRACT
Abnormal immunophenotypes of hematopoietic cells can be detected by flow cytometry (FCM) to assist the diagnosis of myelodysplastic syndromes (MDS). We previously established a FCM scoring system for the diagnosis of low-grade MDS. In this study, additional valuable antigens were involved in an updated FCM scoring system (u-FCMSS) for all MDS subtypes. The u-FCMSS showed better sensitivity and specificity (89.4% and 96.5%) in distinguishing MDS from non-clonal cytopenia diseases. Validation analysis of u-FCMSS exhibited comparable sensitivity and specificity (86.7% and 93.3%) and high agreement rate (88.9%) of FCM diagnosis with morphological diagnosis at optimal cut-off (score 3). The distribution of FCM scores in different disease stages was also analyzed. The results suggested that early scoring from abnormal expression of mature myeloid/lymphoid antigens and advanced scoring from abnormal expression of stem/progenitor antigens expression constituted the majority of FCM scores of low-grade and high-grade MDS, respectively. High early scoring was generally accompanied by low IPSS-R score and superior survival, whereas high advanced scoring was accompanied by high IPSS-R score and inferior survival. In addition, the low-risk MDS patients with high early scoring and low advanced scoring were revealed as candidates for immunosuppressive therapy, whereas those with high advanced scoring and low early scoring may be more suitable for decitabine treatment. In conclusion, the u-FCMSS is a useful tool for diagnosis, prognosis and treatment selection in MDS. Differences in classes of antigens expressed and in distribution of FCM scores may reflect distinctive stage characteristics of MDS during disease progression.

Show MeSH
Related in: MedlinePlus