Premyelodysplastic syndrome (pre-MDS) blood kinetics are linked with both disease risk and overall survival (OS), according to research published in Hematological Oncology.
MDS tends to be diagnosed only at advanced stages, after significant cytopenias have developed. As the diagnostic criteria for MDS include hematopoietic cell dysplasia, patients with chronic cytopenias without dysplasia may not be diagnosed for several years. Some patients present with clonal hematopoiesis of indeterminate potential (CHIP) without significant cytopenia.
The most common cytopenia linked to MDS development is anemia. Studies in this area have suggested that older age, greater mean corpuscular volume, red blood cell distribution width, and lactate dehydrogenase levels raise MDS risk, but these results are inconclusive, owing to small sample sizes and use of only 1 blood count for evaluation.
For this study, researchers evaluated blood counts prior to MDS diagnosis in an effort to determine the genomic changes between the prediagnosis and MDS stages. Participants were grouped by Revised International Prognostic Scoring System risk level, as determined by prediagnosis blood counts (CBCs), and by presence of long-term anemia, defined by documented anemia (hemoglobin [Hbg] of 12 g/dL or less) of any cause for at least 12 months prior to appearance of concerning anemia.
Overall, 420 adult patients were included, among whom the median age was 76 years, 246 (58.6%) were men, and 260 (61.9%) had documented nutritional anemia prior to MDS diagnosis; 232 patients had documented annual CBCs.
In contrast with low-risk patients, patients with high-risk features had faster and greater count decreases in the year prior to appearance of concerning anemia. Both cytopenia development and involvement of multiple hematopoietic cell lines were of prognostic significance.
Among patients with nearly normal CBCs and in whom decreases in multiple hematopoietic cell lines were noted, 5-year OS was 53%, compared with 71% in patients with anemia that progressed slowly.
Patients with mild cytopenia in whom the issue developed after a rapid decrease and where multiple cell lines were involved had a 5-year OS of 34%.
“In conclusion, CBC kinetics can be observed several years prior to the diagnosis of MDS while within normal/near-normal range,” the authors wrote.
Joffe E, Greenbaum U, Man-El G, et al. Kinetics of pre-myelodysplastic syndromes blood values correlate with disease risk and survival [published online July 7, 2020]. Hematol Oncol. doi: 10.1002/hon.2777