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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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The impact of FCM score on patients survival in MDS.(A) The MDS patients with low FCM score had a longer survival, whereas the group with high FCM score had a shorter survival (log rank P<0.001). (B) The MDS patients with low advanced scoring (score 0–3) had a longer survival, whereas the patients with high advanced scoring (score 4–7) had a shorter survival (log rank P<0.001). (C) On the contrary, the MDS patients with high early scoring (score 2–4) had a longer survival, whereas the patients with low early scoring (score 0–1) had a shorter survival (log rank P = 0.011). (D) Interestingly, the MDS patients with high early scoring and high advanced scoring had the worst survival (log rank P<0.001).
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pone-0088706-g006: The impact of FCM score on patients survival in MDS.(A) The MDS patients with low FCM score had a longer survival, whereas the group with high FCM score had a shorter survival (log rank P<0.001). (B) The MDS patients with low advanced scoring (score 0–3) had a longer survival, whereas the patients with high advanced scoring (score 4–7) had a shorter survival (log rank P<0.001). (C) On the contrary, the MDS patients with high early scoring (score 2–4) had a longer survival, whereas the patients with low early scoring (score 0–1) had a shorter survival (log rank P = 0.011). (D) Interestingly, the MDS patients with high early scoring and high advanced scoring had the worst survival (log rank P<0.001).

Mentions: To analyze the effect of FCM score on survival, the FCM score was divided into three categories: low score (score 0–3), medium score (score 4–5) and high score (score 6–10). The log-rank test showed that survival is significantly different among these three groups (log rank P<0.001; Figure 6A). The patients in the group with low scores had longer median overall survival (OS) than those with high scores. Similarly, the median OS was significantly longer in the group with low advanced scoring (score 0–3) than in the group with high advanced scoring (score 4–7) (log rank P<0.001; Figure 6B). However, the patients with high early scoring (score 2–4) showed longer median OS than those with low early scoring (score 0–1) (log rank P = 0.011; Figure 6C).


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)

The impact of FCM score on patients survival in MDS.(A) The MDS patients with low FCM score had a longer survival, whereas the group with high FCM score had a shorter survival (log rank P<0.001). (B) The MDS patients with low advanced scoring (score 0–3) had a longer survival, whereas the patients with high advanced scoring (score 4–7) had a shorter survival (log rank P<0.001). (C) On the contrary, the MDS patients with high early scoring (score 2–4) had a longer survival, whereas the patients with low early scoring (score 0–1) had a shorter survival (log rank P = 0.011). (D) Interestingly, the MDS patients with high early scoring and high advanced scoring had the worst survival (log rank P<0.001).
© Copyright Policy
Related In: Results  -  Collection

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

pone-0088706-g006: The impact of FCM score on patients survival in MDS.(A) The MDS patients with low FCM score had a longer survival, whereas the group with high FCM score had a shorter survival (log rank P<0.001). (B) The MDS patients with low advanced scoring (score 0–3) had a longer survival, whereas the patients with high advanced scoring (score 4–7) had a shorter survival (log rank P<0.001). (C) On the contrary, the MDS patients with high early scoring (score 2–4) had a longer survival, whereas the patients with low early scoring (score 0–1) had a shorter survival (log rank P = 0.011). (D) Interestingly, the MDS patients with high early scoring and high advanced scoring had the worst survival (log rank P<0.001).
Mentions: To analyze the effect of FCM score on survival, the FCM score was divided into three categories: low score (score 0–3), medium score (score 4–5) and high score (score 6–10). The log-rank test showed that survival is significantly different among these three groups (log rank P<0.001; Figure 6A). The patients in the group with low scores had longer median overall survival (OS) than those with high scores. Similarly, the median OS was significantly longer in the group with low advanced scoring (score 0–3) than in the group with high advanced scoring (score 4–7) (log rank P<0.001; Figure 6B). However, the patients with high early scoring (score 2–4) showed longer median OS than those with low early scoring (score 0–1) (log rank P = 0.011; Figure 6C).

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