In a recent study, in patients with myelodysplastic syndromes (MDS), a lower serum level of apolipoprotein A1 (ApoA1) was linked to poorer prognosis. The study was reported in the journal BMC Cancer.

ApoA1 is a lipid metabolite that in the serum may be an indicator of lipid metabolism in tumor cells, the study investigators explained in their report. Serum ApoA1 levels have been linked to disease risk and survival rates with multiple cancer types, but its relevance as a prognostic factor for patients with MDS has not been clear, according to the authors.

This study included patients with MDS treated at Ningbo First Hospital in Ningbo, China. Data from patients were retrospectively evaluated to determine the prognostic value of serum ApoA1 levels in the context of MDS outcomes. Patients were assigned throughout analyses into a high-ApoA1 group and a low-ApoA1 group, with low ApoA1 defined as ≤1.02 g/dL of ApoA1, and high ApoA1 above this threshold. ApoA1 levels were also assessed in donors without MDS for comparison. In patients with MDS, the researchers also performed cytogenetic and mutational analyses and evaluations of the morphology of MDS myeloid cells.

Continue Reading

The study included 228 patients with MDS, and they had a median age of 62 years (range, 16-90). With data collected over the course of 10 years, the median overall survival (OS) rate was 27 months (range, 0-125), and progression to acute myeloid leukemia was seen in 11.4% of patients. Patients with MDS had a lower median ApoA1 level (1.00 g/L) than was seen in the population of 161 healthy donors (1.33 g/L; P <.0001).

Low ApoA1 was associated with a shorter median OS (19 months) than was seen with high ApoA1 (56 months; P <.0001). Low ApoA1 additionally was linked to a higher rate of TP53 mutation, occurring in 25.0% of patients in the low-ApoA1 group, compared with 0.0% in the high-ApoA1 group (P =.002). Leukemia-free survival, however, appeared to not be associated with ApoA1 levels (P =.367).

Multivariate analyses revealed independent, significant predictors of worse OS with MDS in this study. These were bone marrow blast percentage ≥5% (hazard ratio [HR], 3.160; 95% CI, 2.033-4.912; P <.0001), age ≥60 years (HR, 2.679; 95% CI, 1.697-4.232; P <.0001), Revised International Prognostic Scoring System (IPSS-R) cytogenetic risk group (HR, 1.346; 95% CI, 1.091-1.660; P =.005), and an ApoA1 level ≤1.02 g/L (HR, 1.847; 95% CI, 1.047-3.258; P =.034).

“We demonstrated that decreased ApoA1 level was accompanied by a higher frequency of TP53 mutation and was associated with a poor prognosis in MDS patients,” the study investigators wrote in their report. They concluded that ApoA1 could be used as a prognostic factor for MDS, in addition to IPSS-R scores, and that therapeutic approaches associated with lipid metabolism may have relevance in treating MDS.


Shi C, Gong S, Wu A, et al. Decreased serum apolipoprotein A1 level predicts poor prognosis of patients with de novo myelodysplastic syndromes. BMC Cancer. 2022;22(1):127. doi:10.1186/s12885-022-09248-2