ORIGINAL RESEARCH article
Front. Med.
Sec. Hematology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1558585
Neutropenia (even mild) and Anemia are Poor Prognostic Factors in Myelodysplastic Syndromes
Provisionally accepted
- 1Department of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- 2Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Tel Aviv, Israel
- 3School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Background: Severe neutropenia (ANC<0.8X10 9 /L) indicates poor MDS prognosis (IPSS-R classification). The impact of mild neutropenia is unlcear.We compared baseline and outcomes (not infections) of 50 consecutive patients with neutropenia (Neutp, ANC<1.5X10 9 /L) to 50 non-neutropenic (Non-Neutp).Results: Both groups were similar: Age 74.8yr; 61% males; ECOG 0/1 (91%); comorbidities. In Neutp vs Non-Neutp patients: Hb (9.8 vs 10.9 g/dL); WBC (2.7 vs 7.7X10 9 /L; Lymphocytes (1.2 vs 1.8X10 9 /L); Monocytes (0.46 vs 0.73X10 9 /L); PLT (115 vs 201X10 9 /L). Ferritin was higher (642 vs 304ng/mL, p=0.002). BM dyserythropoiesis was less (50% vs 72%, p=0.04), while dysmyelopoiesis (48% vs 26%) and blasts (3.3% vs 1.1%, p<0.001) were more common. More Neutp patients (60.0%) were classified as HR-IPSSR than Non-Neutp (12.2%, p<0.001).The median OS was shorter (101 vs 122m, but p=0.12); 18 (36%) Neutp vs 6 (12%) Non-Neutp patients transformed to AML (p=0.002), with a shorter TTL (p=0.002). The median time to composite endpoint (death or leukemic transformation) was 82 vs 114m (p=0.035). In a Cox proportional hazard model, CVD affected OS, while cytogenetics and neutropenia affected leukemic transformation and composite outcome.Lymphocytes, monocytes and platelets had no impact on outcomes. Patients with only neutropenia or only anemia (HB<10) had a small, non-significant impact, but patients with both had a profound impact on all outcomes (composite: HR=4.15, 95%CI [2.25 -7.7], p<0.001).Mild neutropenia with are poor prognostic factors in MDS. These patients are more anemic and thrombocytopenic, with BM failure and worse outcomes (OS, leukemic transformation, TTL). The mechanism is still unclear.
Keywords: Myelodysplastic Syndromes, Neutropenia, prognosis, Mortality, Leukemic transformation
Received: 10 Jan 2025; Accepted: 22 May 2025.
Copyright: © 2025 Hausman, Gat, Goldschmidt, Oster and Mittelman. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Howard S. Oster, Department of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Moshe Mittelman, Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, 6997801, Tel Aviv, Israel
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