Contributions
Abstract: PB1913
Type: Publication Only
Background
A prospective study was performed over one year in order to investigate whether suspected myelodysplastic syndromes (MDS) could be detected on a complete blood counts (CBC), the fastest laboratory investigation, performed on the recently developed XN-10® (Sysmex, Kobe, Japan).
Aims
The primary end point was to discriminate MDS patients from normal samples and the secondary end-point was to to distinguish MDS with excess blasts (MDS-EB), MDS with multilineage dysplasia (MDS-MLD), MDS with single lineage dysplasia (MDS-SLD) and MDS with ring sideroblasts and single lineage dysplasia (MDS-RS-SLD) within the MDS group and by comparison with controls as described by the WHO 2016 classification.
Methods
One hundred and thirteen patients were enrolled in the study, for whom a diagnosis of MDS was concluded based on CBC, bone marrow smears examination and karyotype. All patients were free of treatment, including transfusions, at inclusion. They were 63 men and 50 women with a median age of 82 years (range 36-96 yo). CBC were performed on a Sysmex analyzer XN-10®, including classical parameters (hemoglobin level, Mean Corpuscular Volume (MCV), reticulocytes, platelets, neutrophils and extra-parameters i.e. platelets by fluorescene (PLT-F), immature platelets fraction (IPF%), immature reticulocytes fraction (IRF%) and the neutrophils median position on the three axes as well as their dispersion (Neut-WX). For comparison with normal values, results from 707 healthy subjects over 50 years old, for whom CBC were performed on the same analyzer and generated no flag, were used. All had parameters within the normal range according to age. According to the WHO, 37 patients in the cohort had MDS-EB, 35 MDS-MDL (among whom 7 had ring sideroblasts [RS]), 26 MDS-SLD- RS, 12 MDS-SLD without RS and 3 MDS with isolated del(5q). Sixty-two patients had a normal karyotype, 24 displayed anomalies classically reported in MDS, and 8 had complex karyotypes. Among the latter, 7 were associated with MDS-EB.
Results
Both classical and extra parameters indeed showed significant differences between the subgroups tested. Among the whole group of MDS patients, a number of parameters of all lineages were statistically different from the healthy cohort. The median level of hemoglobin was 9,92+1,96 g/dL (p<0,0001), the median MCV (99,24+10,56 fL p<0,0001), reticulocyte counts 44,3x109/L (range 8-165,9; p=0,041) and IRF% 16,7% (range 2,4-50,9; p<0,0001). The median platelet count was 194 +128x109/L (p<0,0001) and the median IPF% 8,8% (1,2-42; p<0,0001). Among leukocyte parameters, the MDS median neutrophil count was significantly lower at 3,08+2,58x109/L (p<0,001) while Neut-WX was significantly higher (387+71;p<0,0001). The latter, allowed to predict a diagnosis of MDS with 73% sensitivity and 97% specificity. For patients over 50 years old, 4 parameters (Neut, Neut-WX, hemoglobin level and MCV) in a score allow to diagnose MDS with 92% sensitivity and 81% specificity . When considering MDS subgroups, although each of them was significantly different from controls for hemoglobin levels, MCV and IRF% and (p<0,0001), they could not be discriminated by these parameters. In the subgroup of MDS with single lineage dysplasia and ring sideroblasts, platelet counts were similar to those of controls, yet significantly higher than for MD-EB or MDS-MLD (p=0,004 and p=0,029 respectively). Moreover, neutrophils counts were significantly lower in MDS-DML or MDS-EB than in MDS-SLD-RS.
Conclusion
This study demonstrates that a simple CBC allows to screen for MDS using a multiparameter score including Neut-WX. Blood smear examination should be performed in this situation even if the XN-10® analyzer does not raise any alarm, especially in unknown patients older than 50.
Session topic: 9. Myelodysplastic syndromes - Biology
Keyword(s): Neutrophil, Myelodysplasia, Hemoglobin, WHO classification
Abstract: PB1913
Type: Publication Only
Background
A prospective study was performed over one year in order to investigate whether suspected myelodysplastic syndromes (MDS) could be detected on a complete blood counts (CBC), the fastest laboratory investigation, performed on the recently developed XN-10® (Sysmex, Kobe, Japan).
Aims
The primary end point was to discriminate MDS patients from normal samples and the secondary end-point was to to distinguish MDS with excess blasts (MDS-EB), MDS with multilineage dysplasia (MDS-MLD), MDS with single lineage dysplasia (MDS-SLD) and MDS with ring sideroblasts and single lineage dysplasia (MDS-RS-SLD) within the MDS group and by comparison with controls as described by the WHO 2016 classification.
Methods
One hundred and thirteen patients were enrolled in the study, for whom a diagnosis of MDS was concluded based on CBC, bone marrow smears examination and karyotype. All patients were free of treatment, including transfusions, at inclusion. They were 63 men and 50 women with a median age of 82 years (range 36-96 yo). CBC were performed on a Sysmex analyzer XN-10®, including classical parameters (hemoglobin level, Mean Corpuscular Volume (MCV), reticulocytes, platelets, neutrophils and extra-parameters i.e. platelets by fluorescene (PLT-F), immature platelets fraction (IPF%), immature reticulocytes fraction (IRF%) and the neutrophils median position on the three axes as well as their dispersion (Neut-WX). For comparison with normal values, results from 707 healthy subjects over 50 years old, for whom CBC were performed on the same analyzer and generated no flag, were used. All had parameters within the normal range according to age. According to the WHO, 37 patients in the cohort had MDS-EB, 35 MDS-MDL (among whom 7 had ring sideroblasts [RS]), 26 MDS-SLD- RS, 12 MDS-SLD without RS and 3 MDS with isolated del(5q). Sixty-two patients had a normal karyotype, 24 displayed anomalies classically reported in MDS, and 8 had complex karyotypes. Among the latter, 7 were associated with MDS-EB.
Results
Both classical and extra parameters indeed showed significant differences between the subgroups tested. Among the whole group of MDS patients, a number of parameters of all lineages were statistically different from the healthy cohort. The median level of hemoglobin was 9,92+1,96 g/dL (p<0,0001), the median MCV (99,24+10,56 fL p<0,0001), reticulocyte counts 44,3x109/L (range 8-165,9; p=0,041) and IRF% 16,7% (range 2,4-50,9; p<0,0001). The median platelet count was 194 +128x109/L (p<0,0001) and the median IPF% 8,8% (1,2-42; p<0,0001). Among leukocyte parameters, the MDS median neutrophil count was significantly lower at 3,08+2,58x109/L (p<0,001) while Neut-WX was significantly higher (387+71;p<0,0001). The latter, allowed to predict a diagnosis of MDS with 73% sensitivity and 97% specificity. For patients over 50 years old, 4 parameters (Neut, Neut-WX, hemoglobin level and MCV) in a score allow to diagnose MDS with 92% sensitivity and 81% specificity . When considering MDS subgroups, although each of them was significantly different from controls for hemoglobin levels, MCV and IRF% and (p<0,0001), they could not be discriminated by these parameters. In the subgroup of MDS with single lineage dysplasia and ring sideroblasts, platelet counts were similar to those of controls, yet significantly higher than for MD-EB or MDS-MLD (p=0,004 and p=0,029 respectively). Moreover, neutrophils counts were significantly lower in MDS-DML or MDS-EB than in MDS-SLD-RS.
Conclusion
This study demonstrates that a simple CBC allows to screen for MDS using a multiparameter score including Neut-WX. Blood smear examination should be performed in this situation even if the XN-10® analyzer does not raise any alarm, especially in unknown patients older than 50.
Session topic: 9. Myelodysplastic syndromes - Biology
Keyword(s): Neutrophil, Myelodysplasia, Hemoglobin, WHO classification