Comparison of five diagnostic flow cytometry scores in patients with myelodysplastic syndromes: Diagnostic power and prognostic impact. Issue 2 (14th August 2021)

• Record Type: Journal Article
• Authors: Oelschlaegel, Uta; Oelschlaeger, Lorenz; von Bonin, Malte; Kramer, Michael; Sockel, Katja; Mohr, Brigitte; Wagenfuehr, Lisa; Kroschinsky, Frank; Bornhaeuser, Martin; Platzbecker, Uwe
• Other Names: Kern Wolfgang guestEditor.; van de Loosdrecht Arjan guestEditor.
• Is Part Of: Cytometry. Volume 104:Issue 2(2023)
• Page Start: 141
• Page End: 150
• Publication Date: 2021-08-14
• Subjects: flow cytometry scores -- iFS -- myelodysplastic syndrome; Flow cytometry -- Diagnostic use -- Periodicals; Cytodiagnosis -- Periodicals; 616.07582
• DOI: 10.1002/cyto.b.22030
• Languages: English
• ISSNs: 1552-4949

Abstract

Abstract: Background: Flow cytometry (FCM) is a co‐criterion in myelodysplastic syndromes (MDS) diagnostics according to the WHO classification. The presented study compared diagnostic power and prognostic impact of different FCM‐based scores. Methods: A total of 807 bone marrow (BM) samples of patients with cytopenia (543 MDS, 153 non‐clonal cytopenias, 111 non‐MDS myeloid malignancies) and 78 healthy controls have been investigated using a standardized 8‐color‐FCM procedure. FCSS, Ogata‐score, iFS, RED‐score, and ELN‐NEC were analyzed for sensitivity and specificity in comparison to standard diagnostic tools. Median follow up for patients was 26 month (range: 0.2–89). Results: The iFS showed the highest accuracy (80%) with the best balance between sensitivity (79%) and specificity (86%). This was also valid in MDS with very low IPSS‐R and even in MDS without ring sideroblasts, with normal blast count and karyotype, where iFS could confirm diagnosis in 62% and 65% of patients. Besides the high diagnostic power, the established iFS category "consistent with MDS" was associated with inferior overall survival (OS) independent from WHO classification (median: 51 month vs. not reached, p < 0.0001). Remarkably, this iFS category redefined a subgroup of patients with worse OS within IPSS‐R low‐risk category (73 month vs. not reached, p = 0.0433). Finally, multivariable analysis showed that iFS added independent prognostic information regarding OS besides IPSS‐R. Conclusions: The iFS separates non‐clonal cytopenias and MDS with the highest accuracy, provided information in addition to standard diagnostic procedures, and refined established prognostic tools for outcome prediction.