Assessment of B-lymphocyte and T-lymphocyte function in patients with myelodysplastic syndromes

Abstract

Background An activated immune system has been observed in patients with myelodysplastic syndrome (MDS), but its exact contribution to disease development and control has not been fully clarified. The successful use of immunosuppressive therapies, the potentially curative role of allogeneic stem cell transplant, and the more recent data showing improved peripheral cytopenias and elimination of certain common cytogenetic abnormalities with immunomodulatory agents highlight the role immune dysregulation in the development of MDS. Aim The aim of this study is to assess B-cell and T-cell function in patients with MDS and correlate them to the risk status of MDS. Patients and methods The study included 30 adult Egyptian patients diagnosed with MDS based on blood picture, bone marrow (BM) examination, and cytogenetic studies. Patients were classified according to International Prognostic Scoring System risk scoring system. Immune system assessment was done by performing antinuclear antibodies, direct Coombs test, serum protein electrophoresis, and CD4/CD8 ratio in peripheral blood. Results We have found an association between inverted CD4/CD8 ratio and higher risk strata, presence of neutropenia, and transfusion dependence. Regarding humoral immune system involvement, a positive Coombs test was related significantly to younger age and higher BM blasts count. Marked polyclonal gammopathy as well was found to be associated with higher BM blasts count and presence of cytogenetic abnormalities. Conclusion Immune dysregulation, in the form of inverted CD4/CD8 ratio, positive antinuclear antibodies, positive Coombs test, and polyclonal gammopathy, is well documented in MDS. It is probably related to younger age, higher International Prognostic Scoring System risk, higher BM blasts count, and the presence of cytogenetic abnormalities.