title: Prognostic relevance of lymphocytopenia, monocytopenia and lymphocyte-to-monocyte ratio in primary myelodysplastic syndromes: a single center experience in 889 patients.
abstract: Current prognostic models for myelodysplastic syndromes (MDS), including the Revised International Prognostic Scoring System (IPSS-R), do not account for host immunity. We retrospectively examined the prognostic relevance of monocytopenia, lymphocytopenia and lymphocyte-to-monocyte ratio (LMR) in a cohort of 889 patients with primary MDS. After a median follow-up of 27 months, 712 (80%) deaths and 116 (13%) leukemic transformation were documented. In univariate analysis, subnormal absolute lymphocyte count (ALC) <0.9 × 109/l; P=0.001), ALC<1.2 × 109/l (P=0.0002), subnormal absolute monocyte count (AMC) <0.3 × 109/l (P=0.0003), LMR (P⩽0.0001) and LMR⩾5 (P=0.03) were all associated with inferior overall survival. In multivariable analysis that included other risk factors, significance was retained for LMR (P=0.02) and became borderline for ALC <1.2 × 109/l (P=0.06). Analysis in the context of IPSS-R resulted in P-values of 0.06 for ALC<1.2 × 109/l, 0.7 for monocytopenia and 0.2 for LMR. Leukemia-free survival was not affected by ALC, AMC or LMR. The observations from the current study suggest a possible detrimental role for altered host immunity in primary MDS, which might partly explain the therapeutic benefit of immune-directed therapy, including the use of immune modulators; however, IPSS-R-independent prognostic value for either ALC or AMC was limited.
authors.affiliation: Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA.
authors.forename: L
authors.initials: L
authors.lastname: Saeed
authors.affiliation: Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Patnaik
authors.affiliation: Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA.
authors.forename: K H
authors.initials: KH
authors.lastname: Begna
authors.affiliation: Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA.
authors.forename: A
authors.initials: A
authors.lastname: Al-Kali
authors.affiliation: Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Litzow
authors.affiliation: Department of Laboratory Medicine, Division of Hematopathology, Mayo Clinic, Rochester, MN, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Hanson
authors.affiliation: Department of Laboratory Medicine, Division of Cytogenetics, Mayo Clinic, Rochester, MN, USA.
authors.forename: R P
authors.initials: RP
authors.lastname: Ketterling
authors.affiliation: Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA.
authors.forename: L F
authors.initials: LF
authors.lastname: Porrata
authors.affiliation: Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA.
authors.forename: A
authors.initials: A
authors.lastname: Pardanani
authors.affiliation: Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA.
authors.forename: N
authors.initials: N
authors.lastname: Gangat
authors.affiliation: Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA.
authors.forename: A
authors.initials: A
authors.lastname: Tefferi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001853:Bone Marrow / Q000378:metabolism / Q000473:pathology; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes; D008231:Lymphopenia / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D009190:Myelodysplastic Syndromes / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult