Limits...
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.

Show MeSH

Related in: MedlinePlus

Correlation of FCM score with WHO classification and IPSS-R in MDS.(A) The FCM score in RA/RARS/MDS-U, RCMD/RCMD-RS, RAEB-1, and RAEB-2 is significantly increased compared with that in patients with non-clonal cytopenias diseases (all P<0.05). FCM score in MDS had a positive correlation with WHO classification (Spearman r = 0.312, P = 0.005). (B) FCM early scoring in RCMD/RCMD-RS is significantly higher than that in RAEB-1 and RAEB-2 (P = 0.003; P = 0.009). FCM early-scoring in MDS had an inverse correlation with WHO classification (Spearman r = −0.258, P = 0.009). (C) FCM advanced scoring in RAEB-1 or RAEB-2 is significantly higher than that in RA/RARS/MDS-U and RCMD/RCMD-RS (P<0.001; P<0.001). FCM advanced scoring between each adjacent subgroup differed significantly (all P<0.05). FCM advanced-scoring in MDS had a strong positive correlation with WHO classification (Spearman r = 0.471, P<0.001). (D) FCM score had a positive correlation with IPSS-R prognosis classification (Spearman r = 0.379, P<0.001). (E) FCM early scoring in MDS showed reverse correlation with IPSS prognosis classification (Spearman r = −0.213, P = 0.004). (F) FCM advanced scoring in MDS had a strong positive correlation with IPSS prognosis classification (Spearman r = 0.539, P<0.001). FCM total score (G) and advanced scoring (I) showed significantly correlation with cytogenetic prognosis (Spearman r = 0.379, P<0.001; r = 0.538, P<0.001), but FCM early scoring (H) had a reverse correlation with cytogenetic prognosis (Spearman r = −0213, P = 0.004). *, P<0.05; **, P<0.01; ***, P<0.001.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3928275&req=5

pone-0088706-g003: Correlation of FCM score with WHO classification and IPSS-R in MDS.(A) The FCM score in RA/RARS/MDS-U, RCMD/RCMD-RS, RAEB-1, and RAEB-2 is significantly increased compared with that in patients with non-clonal cytopenias diseases (all P<0.05). FCM score in MDS had a positive correlation with WHO classification (Spearman r = 0.312, P = 0.005). (B) FCM early scoring in RCMD/RCMD-RS is significantly higher than that in RAEB-1 and RAEB-2 (P = 0.003; P = 0.009). FCM early-scoring in MDS had an inverse correlation with WHO classification (Spearman r = −0.258, P = 0.009). (C) FCM advanced scoring in RAEB-1 or RAEB-2 is significantly higher than that in RA/RARS/MDS-U and RCMD/RCMD-RS (P<0.001; P<0.001). FCM advanced scoring between each adjacent subgroup differed significantly (all P<0.05). FCM advanced-scoring in MDS had a strong positive correlation with WHO classification (Spearman r = 0.471, P<0.001). (D) FCM score had a positive correlation with IPSS-R prognosis classification (Spearman r = 0.379, P<0.001). (E) FCM early scoring in MDS showed reverse correlation with IPSS prognosis classification (Spearman r = −0.213, P = 0.004). (F) FCM advanced scoring in MDS had a strong positive correlation with IPSS prognosis classification (Spearman r = 0.539, P<0.001). FCM total score (G) and advanced scoring (I) showed significantly correlation with cytogenetic prognosis (Spearman r = 0.379, P<0.001; r = 0.538, P<0.001), but FCM early scoring (H) had a reverse correlation with cytogenetic prognosis (Spearman r = −0213, P = 0.004). *, P<0.05; **, P<0.01; ***, P<0.001.

Mentions: The relationship between the FCM score and the different morphologic subgroups is shown in Figures 3A, 3B and 3C. The FCM score in the RA/RARS, RCMD/RCMD-RS, RAEB-1, and RAEB-2 is significantly increased compared with that in the patients with non-clonal cytopenias (Figure 3A). FCM score in MDS had a positive correlation with WHO classification (Spearman r = 0.312, P = 0.005). Although the FCM score is heterogeneous within each subgroup, FCM early scoring in RCMD/RCMD-RS is significantly higher than in RAEB-1 and RAEB-2 (P = 0.003; P = 0.009) (Figure 3B). FCM early scoring in MDS had an inverse correlation with WHO classification (Spearman r = −0.258, P = 0.009). FCM advanced scoring in RAEB-1 is significantly higher than in RCMD/RCMD-RS and RA/RARS (P<0.001; P<0.001) (Figure 3C). FCM advanced scoring differed significantly between each pair of subgroups (all P<0.05). FCM advanced scoring in MDS had a strong positive correlation with WHO classification (Spearman r = 0.471, P<0.001). In brief, the patients with low-grade MDS showed high early scoring, whereas the patients with high-grade MDS showed high 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)

Correlation of FCM score with WHO classification and IPSS-R in MDS.(A) The FCM score in RA/RARS/MDS-U, RCMD/RCMD-RS, RAEB-1, and RAEB-2 is significantly increased compared with that in patients with non-clonal cytopenias diseases (all P<0.05). FCM score in MDS had a positive correlation with WHO classification (Spearman r = 0.312, P = 0.005). (B) FCM early scoring in RCMD/RCMD-RS is significantly higher than that in RAEB-1 and RAEB-2 (P = 0.003; P = 0.009). FCM early-scoring in MDS had an inverse correlation with WHO classification (Spearman r = −0.258, P = 0.009). (C) FCM advanced scoring in RAEB-1 or RAEB-2 is significantly higher than that in RA/RARS/MDS-U and RCMD/RCMD-RS (P<0.001; P<0.001). FCM advanced scoring between each adjacent subgroup differed significantly (all P<0.05). FCM advanced-scoring in MDS had a strong positive correlation with WHO classification (Spearman r = 0.471, P<0.001). (D) FCM score had a positive correlation with IPSS-R prognosis classification (Spearman r = 0.379, P<0.001). (E) FCM early scoring in MDS showed reverse correlation with IPSS prognosis classification (Spearman r = −0.213, P = 0.004). (F) FCM advanced scoring in MDS had a strong positive correlation with IPSS prognosis classification (Spearman r = 0.539, P<0.001). FCM total score (G) and advanced scoring (I) showed significantly correlation with cytogenetic prognosis (Spearman r = 0.379, P<0.001; r = 0.538, P<0.001), but FCM early scoring (H) had a reverse correlation with cytogenetic prognosis (Spearman r = −0213, P = 0.004). *, P<0.05; **, P<0.01; ***, P<0.001.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0088706-g003: Correlation of FCM score with WHO classification and IPSS-R in MDS.(A) The FCM score in RA/RARS/MDS-U, RCMD/RCMD-RS, RAEB-1, and RAEB-2 is significantly increased compared with that in patients with non-clonal cytopenias diseases (all P<0.05). FCM score in MDS had a positive correlation with WHO classification (Spearman r = 0.312, P = 0.005). (B) FCM early scoring in RCMD/RCMD-RS is significantly higher than that in RAEB-1 and RAEB-2 (P = 0.003; P = 0.009). FCM early-scoring in MDS had an inverse correlation with WHO classification (Spearman r = −0.258, P = 0.009). (C) FCM advanced scoring in RAEB-1 or RAEB-2 is significantly higher than that in RA/RARS/MDS-U and RCMD/RCMD-RS (P<0.001; P<0.001). FCM advanced scoring between each adjacent subgroup differed significantly (all P<0.05). FCM advanced-scoring in MDS had a strong positive correlation with WHO classification (Spearman r = 0.471, P<0.001). (D) FCM score had a positive correlation with IPSS-R prognosis classification (Spearman r = 0.379, P<0.001). (E) FCM early scoring in MDS showed reverse correlation with IPSS prognosis classification (Spearman r = −0.213, P = 0.004). (F) FCM advanced scoring in MDS had a strong positive correlation with IPSS prognosis classification (Spearman r = 0.539, P<0.001). FCM total score (G) and advanced scoring (I) showed significantly correlation with cytogenetic prognosis (Spearman r = 0.379, P<0.001; r = 0.538, P<0.001), but FCM early scoring (H) had a reverse correlation with cytogenetic prognosis (Spearman r = −0213, P = 0.004). *, P<0.05; **, P<0.01; ***, P<0.001.
Mentions: The relationship between the FCM score and the different morphologic subgroups is shown in Figures 3A, 3B and 3C. The FCM score in the RA/RARS, RCMD/RCMD-RS, RAEB-1, and RAEB-2 is significantly increased compared with that in the patients with non-clonal cytopenias (Figure 3A). FCM score in MDS had a positive correlation with WHO classification (Spearman r = 0.312, P = 0.005). Although the FCM score is heterogeneous within each subgroup, FCM early scoring in RCMD/RCMD-RS is significantly higher than in RAEB-1 and RAEB-2 (P = 0.003; P = 0.009) (Figure 3B). FCM early scoring in MDS had an inverse correlation with WHO classification (Spearman r = −0.258, P = 0.009). FCM advanced scoring in RAEB-1 is significantly higher than in RCMD/RCMD-RS and RA/RARS (P<0.001; P<0.001) (Figure 3C). FCM advanced scoring differed significantly between each pair of subgroups (all P<0.05). FCM advanced scoring in MDS had a strong positive correlation with WHO classification (Spearman r = 0.471, P<0.001). In brief, the patients with low-grade MDS showed high early scoring, whereas the patients with high-grade MDS showed high 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