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Gursoy V, Sadri S, Kucukelyas HD, Hunutlu FC, Pinar IE, Yegen ZS, Alkış N, Ersal T, Ali R, Ozkocaman V, Ozkalemkas F. HALP score as a novel prognostic factor for patients with myelodysplastic syndromes. Sci Rep 2024; 14:13843. [PMID: 38879594 PMCID: PMC11180126 DOI: 10.1038/s41598-024-64166-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 06/05/2024] [Indexed: 06/19/2024] Open
Abstract
Myelodysplastic syndrome (MDS) is a heterogeneous spectrum of clonal hematopoietic disorders with varying degrees of cytopenia and morphologic dysplasia. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is a prognostic marker in several types of malignant tumors. Prognostic value of HALP score remains unclear for MDS. To determine the prognostic value of baseline HALP score in MDS. We retrospectively analyzed data from 130 newly diagnosed MDS patients evaluated and classified under HALP score. By the receiver operating characteristic (ROC) analysis, the optimal cut-off value of HALP was > 67.5 in predicting mortality. Patients were divided into two groups: with low and high HALP scores, and the characteristics were compared between both groups. Patients' median age was 68 (19-84) years, and 79 (60.8%) were male. Higher HALP score was detected in MDS patients with intermediate-risk under IPSS score, and at high and very high risks under IPSS-R score, and those receiving azacitidine (AZA) treatment. The survival rates of those with a HALP score > 67.5 were significantly lower than those with low HALP score at 17.77 ± 3.98 (median ± SE) (p < 0.001). The 3-, 5- and 10-years survival rates of individuals with HALP scores > 67.5 were found as 25, 18, and 11%, respectively. Median overall survival (OS) was also determined as 33.10 (95% CI 16.34-49.88) months by the Kaplan-Meier method. HALP score has shown an ability to be a useful prognostic biomarker in various cancers, including MDS. The meaningful cut-off value of HALP is disease-specific and largely study-specific. High HALP score is associated with unfavorable clinicopathological characteristics. Also, it may be useful in predicting OS and mortality of MDS.
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Affiliation(s)
- Vildan Gursoy
- Department of Hematology, Bursa City Hospital, Bursa, Turkey.
| | - Sevil Sadri
- Department of Hematology, Bursa City Hospital, Bursa, Turkey
| | | | | | | | | | - Nihan Alkış
- Department of Hematology, Bursa City Hospital, Bursa, Turkey
| | - Tuba Ersal
- Department of Hematology, Uludag University Medical Faculty, Bursa, Turkey
| | - Ridvan Ali
- Department of Hematology, Uludag University Medical Faculty, Bursa, Turkey
| | - Vildan Ozkocaman
- Department of Hematology, Uludag University Medical Faculty, Bursa, Turkey
| | - Fahir Ozkalemkas
- Department of Hematology, Uludag University Medical Faculty, Bursa, Turkey
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Qu H, Chu J, Wang L, Zhang J, Han J, Li Z, Hou H, Wang Y, Liu Y, Wu H. Platelet-to-lymphocyte ratio and absolute monocyte count have prognostic potential in primary myelodysplastic neoplasms. Int J Lab Hematol 2024; 46:275-285. [PMID: 38105483 DOI: 10.1111/ijlh.14215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/24/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION The platelet-to-lymphocyte ratio (PLR), peripheral blood absolute monocyte count (AMC), and monocyte-to-lymphocyte ratio (MLR) are considered biomarkers of systemic immune and inflammation response. However, their prognostic potential in patients with myelodysplastic neoplasms (MDS) remains unclear. This study aimed to explore the predictive impact of PLR, MLR, and AMC on MDS outcomes. METHODS In total, 334 patients with primary MDS were included between January 2016 and December 2021 and were retrospectively followed up until December 31, 2022. The prognostic significance of PLR, MLR, and AMC was assessed using univariate and multivariate analyses, and predictive models were generated to estimate MDS outcomes. The area under their receiver operating curves was computed to compare the predictive power of these models. RESULTS Fifty-one patients had disease progression, and 103 patients died during follow-up. In multivariate analyses, a higher PLR was an adverse independent factor for overall survival (OS) (p = 0.011), whereas a higher AMC indicated shorter progression-free survival (p = 0.003). The prognostic model incorporating PLR, MLR, and AMC with the Revised International Prognostic Scoring System (IPSS-R) risk categorization showed higher performance in predicting OS than the model that only utilized the IPSS-R category. CONCLUSION Elevated PLR and increased AMC had independent prognostic value for adverse outcomes in patients with MDS. PLR, MLR, and AMC enhanced the IPSS-R risk categorization for OS prediction in MDS.
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Affiliation(s)
- Huiting Qu
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong First Medical University, Jinan, Shandong, China
| | - Jingxue Chu
- Department of Clinical Laboratory, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Lu Wang
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Jie Zhang
- Department of Clinical Laboratory, Yinan People's Hospital, Linyi, Shandong, China
| | - Jingyin Han
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zhen Li
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Haifeng Hou
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Yong Wang
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yigang Liu
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Huanling Wu
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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Yun JP, Ding PQ, Dolley A, Cheung WY. Decitabine/Cedazuridine in the Management of Myelodysplastic Syndrome and Chronic Myelomonocytic Leukemia in Canada. Curr Oncol 2023; 30:8005-8018. [PMID: 37754496 PMCID: PMC10528038 DOI: 10.3390/curroncol30090581] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
The management of myelodysplastic syndrome (MDS) and chronic myelomonocytic leukemia (CMML) is limited and remains an unmet need. Decitabine/cedazuridine (DEC-C, ASTX727) is Canada's first and only approved oral hypomethylating agent for MDS and CMML. We characterized the real-world use of DEC-C through a Canadian compassionate use program. Demographic and clinical data from 769 patients enrolled in Taiho Pharma Canada's Patient Support Program were collected and analyzed. These patients represent a collection period from 10 November 2020 to 31 August 2022 with a median age of 76 years. Among 651 patients who started DEC-C, the median treatment duration was 4.2 cycles. The median overall and progression-free survival were 21.6 and 10.7 months, respectively. Among 427 patients who discontinued treatment, the majority (69.5%) stopped due to death (n = 164) or disease progression (n = 133). Multivariable cox regression showed that age, province of residence, blast counts, antibiotic prophylaxis, and number of dose reductions and delays were not significantly associated with overall and progression-free survival. DEC-C is a promising alternative to parenteral hypomethylating agent therapy, and it likely addresses an important unmet need for effective and convenient therapies in this setting.
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Affiliation(s)
- John Paul Yun
- Oncology Outcomes Program, Department of Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada; (J.P.Y.); (P.Q.D.)
- Galway University Hospital, H91 YR71 Galway, Ireland
| | - Philip Q. Ding
- Oncology Outcomes Program, Department of Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada; (J.P.Y.); (P.Q.D.)
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Aastha Dolley
- Taiho Pharma Canada, Inc., Oakville, ON L6H 5R7, Canada;
| | - Winson Y. Cheung
- Oncology Outcomes Program, Department of Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada; (J.P.Y.); (P.Q.D.)
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
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Silzle T, Blum S, Kasprzak A, Nachtkamp K, Rudelius M, Hildebrandt B, Götze KS, Gattermann N, Lauseker M, Germing U. The Absolute Monocyte Count at Diagnosis Affects Prognosis in Myelodysplastic Syndromes Independently of the IPSS-R Risk Score. Cancers (Basel) 2023; 15:3572. [PMID: 37509235 PMCID: PMC10377210 DOI: 10.3390/cancers15143572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/04/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023] Open
Abstract
The absolute monocyte count (AMC) is associated with mortality in a variety of medical conditions. Its prognostic impact in myelodysplastic syndromes (MDSs) is less well studied. Therefore, we investigated its potential prognostic value in a cohort from the Düsseldorf MDS registry in relationship to the revised international prognostic scoring system (IPSS-R). An AMC below the population's median (<0.2 × 109/L) was associated with several adverse disease features such as lower haemoglobin levels, lower count of neutrophils and platelets, and a higher percentage of blasts in the bone marrow. MDS patients with an AMC < 0.2 × 109/L had a significantly higher risk of progression into acute myeloid leukemia (AML). In a univariate, proportional hazards model the effect of the AMC as a continuous variable was modelled via p-splines. We found a U-shaped effect with the lowest hazard around 0.3 × 109/L. Accordingly, an AMC within the last quartile of the population (0.4 × 109/L) was associated with a reduced overall survival independently of IPSS-R, but not with the risk of secondary AML. Considering monocytopenia as a risk factor for AML progression in MDS may provide an additional argument for allogeneic transplantation or the use of hypomethylating agents in patients who are not clear candidates for those treatments according to current prognostic scoring systems and/or recommendations. Further studies are needed to assess the prognostic impact of the AMC in the context of prognostic scoring systems, considering the molecular risk profile, and to identify the mechanisms responsible for the higher mortality in MDS patients with a subtle monocytosis.
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Affiliation(s)
- Tobias Silzle
- Department of Medical Oncology and Hematology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Sabine Blum
- Service and Central Laboratory of Hematology, University Hospital of Lausanne and Lausanne University, 1011 Lausanne, Switzerland
| | - Annika Kasprzak
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Kathrin Nachtkamp
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Martina Rudelius
- Institute of Pathology, Faculty of Medicine, LMU Munich, 80337 Munich, Germany
| | - Barbara Hildebrandt
- Department of Human Genetics, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Katharina S. Götze
- Department of Internal Medicine III, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Norbert Gattermann
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Michael Lauseker
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, LMU Munich, 81377 Munich, Germany
| | - Ulrich Germing
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
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Liu Z, Xu X, Zheng L, Ding K, Yang C, Huang J, Fu R. The value of serum IL-4 to predict the survival of MDS patients. Eur J Med Res 2023; 28:7. [PMID: 36600245 PMCID: PMC9811803 DOI: 10.1186/s40001-022-00948-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Immune indicators are routinely used for the detection of myelodysplastic syndrome (MDS), but these are not utilized as a reference indicator to assess prognosis in MDS-related prognostic evaluation systems, such as the World Health Organizational prognostic scoring system, the international prostate symptom score, and the revised international prostate symptom score. METHODS We examined immune indicators, including cluster of differentiation (CD)3, CD4, CD8, CD56, CD19, interleukin (IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor-a, and interferon-γ in 155 newly diagnosed MDS patients. We also conducted a correlation analysis with clinical indices. RESULTS IL-4 was found to be a predictor of survival in these 155 patients using the receiver operating characteristic curve, with 5.155 as the cut-off point. Patients with serum IL-4 levels ≥ 5.155 had a lower overall survival (OS) than those with IL-45.155 at diagnosis. Furthermore, multivariate analysis revealed that IL-4 levels > 5.155 were an independent predictor of OS (hazard ratio: 0.237; 95% confidence interval, 0.114-0.779; P = 0.013). In addition, serum IL-4 expression in the three different scoring systems showed significant differences in the survival of medium- to high-risk MDS patients (P = 0.014, P < 0.001, P < 0.001). CONCLUSIONS According to our study, IL-4 levels at the time of diagnosis can predict MDS prognosis in patients as a simple index reflecting host systemic immunity.
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Affiliation(s)
- Zhaoyun Liu
- grid.412645.00000 0004 1757 9434Department of Hematology, Tianjin Medical University General Hospital, Tianjin, 300052 China
| | - Xintong Xu
- grid.412645.00000 0004 1757 9434Department of Hematology, Tianjin Medical University General Hospital, Tianjin, 300052 China
| | - Likun Zheng
- grid.412645.00000 0004 1757 9434Department of Hematology, Tianjin Medical University General Hospital, Tianjin, 300052 China
| | - Kai Ding
- grid.412645.00000 0004 1757 9434Department of Hematology, Tianjin Medical University General Hospital, Tianjin, 300052 China
| | - Chun Yang
- grid.412645.00000 0004 1757 9434Department of Hematology, Tianjin Medical University General Hospital, Tianjin, 300052 China
| | - Jincheng Huang
- grid.412645.00000 0004 1757 9434Department of Hematology, Tianjin Medical University General Hospital, Tianjin, 300052 China
| | - Rong Fu
- grid.412645.00000 0004 1757 9434Department of Hematology, Tianjin Medical University General Hospital, Tianjin, 300052 China
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Liang H, Feng Y, Guo Y, Jian J, Zhao L, Luo X, Tao L, Liu B. Development and validation of a novel prognosis prediction model for patients with myelodysplastic syndrome. Front Oncol 2022; 12:1014504. [PMID: 36313674 PMCID: PMC9597308 DOI: 10.3389/fonc.2022.1014504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Somatic mutations are widespread in patients with Myelodysplastic Syndrome (MDS) and are associated with prognosis. However, a practical prognostic model for MDS that incorporates somatic mutations urgently needs to be developed. Methods A cohort of 201 MDS patients from the Gene Expression Omnibus (GEO) database was used to develop the model, and a single-center cohort of 115 MDS cohorts from Northwest China was used for external validation. Kaplan-Meier analysis was performed to compare the effects of karyotype classifications and gene mutations on the prognosis of MDS patients. Univariate and multivariate Cox regression analyses and Lasso regression were used to screen for key prognostic factors. The shinyapps website was used to create dynamic nomograms with multiple variables. The time-dependent receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA) were used to evaluate the model’s discrimination, accuracy and clinical utility. Results Six risk factors (age, bone morrow blast percentage, ETV6, TP53, EZH2, and ASXL1) were considered as predictor variables in the nomogram. The nomogram showed excellent discrimination, with respective the area under the ROC curve (AUC) values of 0.850, 0.839, 0.933 for the training cohort at 1 year, 3 years and 5 years; 0.715, 0.802 and 0.750 for the testing cohort at 1 year, 3 years and 5 years; and 0.668, 0.646 and 0.731 for the external validation cohort at 1 year, 3 years and 5 years. The calibration curves and decision curve showed that the nomogram had good consistency and clinical practical benefit. Finally, a stratified analysis showed that MDS patients with high risk had worse survival outcomes than patients with low risk. Conclusion We developed a nomogram containing six risk factors, which provides reliable and objective predictions of prognosis for MDS patients.
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Affiliation(s)
- Haiping Liang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Yue Feng
- Department of Blood Transfusion, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yuancheng Guo
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Jinli Jian
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Long Zhao
- Department of Hematology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Xingchun Luo
- Department of Hematology, Xi’an Central Hospital, Xi’an, China
| | - Lili Tao
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Bei Liu
- Department of Hematology, The First Hospital of Lanzhou University, Lanzhou, China
- *Correspondence: Bei Liu,
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