Retrospective evaluation of demographic characteristics, FISH / cytogenetic data and survi̇val analysis of patients with myelodysplastic syndromes

INTRODUCTION AND AİM: Myelodysplastic syndrome (MDS) is a clonal, heterogeneous group of hematopoietic stem cell disease with risk of conversion to acute myeloid leukemia characterized by abnormal cellular proliferation and dysplasia in the bone marrow, cytopenia in surrounding blood. Treatment of the disease is based on prognostic considerations. Prognostic scoring is based on the World Health Organization (WHO) classification system based on a combination of morphology, immunophenotype, genetic and clinical features. In this study, we aimed to evaluate the cytogenetic / FISH and demographic data, prognostic features and survival of patients with MDS who were followed up by the Department of Hematology, Department of Internal Medicine, Dokuz Eylül University Faculty of Medicine (DEUTF). MATERİALS AND METHODS: MDS patients followed by DEUTF Hematology Department between 01.01.2010 - 31.01.2018 were included in the study. Demographic characteristics and laboratory data of the patients were retrospectively screened. RESULTS: The median age of 205 patients with MDS was 72 (27-92) years and the female / male ratio was 0.8 / 1 (55.6% male, 48.3% female). At the end of the median follow-up period of 24 months (± 20.79 months), 99 (48.3%) of the patients were live and 106 (51.7%) were ex. Overall median survival was 35 ± 6 months (23.22 - 46.77). Patients were evaluated in terms of CCI, gender, serum albumin level, ferritin level, bone marrow dysplasia, cellularity, fibrosis, presence of lymphoid aggregate, CD 34 clustering, presence of FISH / Cytogenetic anomaly, IPSS classification, blood product requirements and survival effect of MDS subtypes. When the transfusion needs of the cases were evaluated, the annual erythrocyte transfusion requirement of the MDS-MLD and SLD group was 19,69 ± 18,03 - 21,71 ± 16,14 units, respectively. In the RAEB group, it was 29.00 ± 18.39 - 22.93 ± 16.68 units for EB1 and EB2, respectively. The survival time of patients in need of blood product replacement was statistically significant (108 months x 24 months p: 0,000 *). Albumin levels had a significant effect on survival (≤4 gr: 24 months x >4 gr: 68 months p: 0,000 *). The survival of patients with less than 1000 mg ferritin was long but not statistically significant (36 ± 6.09 months x 22 ± 5.86 months p: 0.043). Median survival of IPSS high risk group was low. The survival rate of the patients with dysplasia in the myeloid series and high CD 34 (+) ratio was short. In terms of FISH data, del 7q positivity and p53 mutation negatively affected survival. The percentage of P53 staining by bone marrow immunohistochemistry had a negative effect on survival, but was not statistically significant (<5%: 68.00 ± 23.32 months x ≥ 5%: 29.00 ± 5.88 months p: 0.07) . CONCLUSION: IPSS and other scoring systems are very valuable in prognostic classification of MDS, predicting the course of disease, determining treatment plan, estimating the risk of progression to leukemic transformation. Factors such as albumin, cellularity, ferritin levels, bone marrow fibrosis, which are not included in prognostic scoring systems, may have prognostic values on survival. Many studies have shown that these criteria affect survival. Where cytogenetic assessment is not possible, especially albumin may be used as an indicator for the prognosis of patients. However, larger studies are needed to be included in prognostic scoring systems.