The diagnostic and prognostic value of integrated flow-score in myelodysplastic syndrome postprint

Abstract: Background The gold standard for the diagnosis of myelodysplastic syndrome (MDS) is based on bone marrow morphology, progenitor cell count and cytogenetics. But the dysplasia is not specific for MDS, may be very mild. In the context of poor quality of bone marrow smear, no significant increase in blasts and a normal karyotype, the diagnosis of MDS is often challenging. Multiparameter flow cytometry (MFC) has became an important co-criteria for the diagnosis of MDS. Some study showed that integrated flow-score (iFS) was the best scoring system for MDS diagnosis, but no report in the Chinese population. Objective To explore the diagnostic and prognostic value of iFS by MFC in MDS. To find an appropriate MFC scoring system for clinical diagnosis and evaluation of prognosis. Methods The clinical and MFC data of 83 patients with MDS and 77 patients with non-MDS treated in the Hematology Department of the Affiliated People's Hospital of Ningbo University between January 2019 and April 2022 were retrospectively collected. Phenotype abnormalities were judged according to iFS. The Chi-square test was used to compare the probability of phenotype abnormalities in each cell line of the two group patients. Diagnostic scores were performed according to the iFS, and the sensitivities, specificities and the area under the curves (AOC) of iFS were analysed by drawing the receiver operating characteristic (ROC) curve. In the MDS group, the spearman-rank was adopted to analyze the correlation of iFS evaluation grade and Revised International Prognositic Scoring System (IPSS-R). The event-free survival curve was plotted by Kaplan-Meier method and compared patients evaluated as MDS by iFS with the other MDS patients by Log-rank test. Results The probability of phenotype abnormalities of myeloid progenitors, granulocytes/monocytes and erythrocytes in the MDS group (71.1%, 73.5%, 60.2%, respectively) were significantly higher than that in the non-MDS group (1.3%, 18.8%, 14.2%, respectively) (P<0.05). The specificity of iFS in the diagnosis of MDS was 93.5% and the sensitivity was 81.9%. The AOC was 0.921(95%CI：0.876～0.967). The sensitivities in low-grade MDS and low-grade MDS with normal karyotype were 66.7% and 65.0%, respectively. There was positive correlation between the evaluation grade of iFS and IPSS-R (r=0.411，P<0.05). Patients evaluated as MDS by iFS had significantly lower event-free survival time than the other MDS patients (36.4 month vs not reached, χ2=5.71, P<0.05). Conclusion The iFS may compensate for the morphological and cytogenetic limitations to provide diagnostic and prognostic information for MDS.