Influence of platelet count at diagnosis and during the course of disease on prognosis in MDS patients

Judith Strapatsas,Ulrich Germing,Jennifer Kaivers,Martina Rudelius,Elena Calina Barbulescu,Rainer Haas,Barbara Hildebrandt,Kathrin Nachtkamp,Michael Lauseker,Corinna Strupp

doi:10.1007/s00277-021-04608-7

Abstract

Thrombocytopenia at diagnosis and platelet drop within the first 6 months have an adverse effect on prognosis of MDS patients. We therefore were interested in the association and impact on prognosis of morphologic findings of megakaryocytes and platelets with platelet count at diagnosis, bleeding complications, and the drop of platelets during the course of disease. This retrospective analysis was based on 334 MDS patients from the Duesseldorf MDS registry that were followed up for blood counts, bleeding, transfusion dependency, and AML evolution and correlated with morphology of the megakaryocytes and platelets. Thrombocytopenia was found more frequently in higher risk MDS and was associated with hypocellularity of the megakaryocytes in the bone marrow. Signs of bleeding were present at diagnosis in 14% and occurred during the disease in 48% of all MDS patients. Death due to bleeding was ranked third behind infections and AML. A decrement of platelets during the first 6 months was associated with an inferior overall survival of 21 vs. 49 months and with a higher cumulative 2-year AML rate of 22.2% vs. 8.3% (p = 0.001). In a multivariate analysis, besides bone marrow blasts and karyotype, decreasing platelets were also associated with an inferior outcome. Signs of bleeding are present in a relevant number of MDS patients and account for significant morbidity and mortality in MDS. We could demonstrate the prognostic importance of decreasing platelets during the course of disease in all MDS patients, identifying patients at higher risk for death or AML progression.

Highlights

Myelodysplastic syndromes are heterogeneous stem cell disorders characterized by dysplastic features in the bone marrow and various degrees of cytopenia in the peripheralAbout 35–67% of all MDS patients present with thrombocytopenia at the time of diagnosis, whereas isolated thrombocytopenia occurs in less than 10% [3,4,5,6]
When categorizing patients according to the initial platelet count using the International Prognostic Scoring System (IPSS)-R cutoffs, 106 patients presented with platelets > 100,000/μl (32%), 122 had a platelet count between 50,000 and 100,000/μl (37%), and 101 patients (31%) presented with platelets < 50,000/μl, respectively
Thrombocytopenia is a frequent finding in MDS patients

Summary

Introduction

Myelodysplastic syndromes are heterogeneous stem cell disorders characterized by dysplastic features in the bone marrow and various degrees of cytopenia in the peripheralAbout 35–67% of all MDS patients present with thrombocytopenia at the time of diagnosis, whereas isolated thrombocytopenia occurs in less than 10% [3,4,5,6]. Thrombocytopenia in MDS is mainly caused by ineffective platelet production as a result of disturbed proliferation and maturation of megakaryocytes or their precursors [7]. Cytogenetic studies revealed that even in the case of a normal appearance on light microscopy, the majority of megakaryocytes are part of the MDS clone [8]. It is well known that the initial platelet count is an important prognostic parameter, data on the clinical course of the patients with low platelets during the course of the disease are sparse. Besides AML evolution, infections and bleeding complications are the most frequent causes of death [9]. Death due to bleeding complications is found in patients with low platelet counts and in patients with higher or even normal

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Conclusion