Comparison of five diagnostic flow cytometry scores in patients with myelodysplastic syndromes: Diagnostic power and prognostic impact

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.

Multicenter prospective evaluation of diagnostic potential of flow cytometric aberrancies in myelodysplastic syndromes by theELN iMDSflow working group

“…So far, none of them (reviewed inDuetz et al (2019),Oelschlaegel et al (2021), andWesters et al (2012)) can be considered the gold standard.The Ogata score relies on only four parameters and is therefore convenient and relatively simple to determine in clinical routine. Its reported T A B L E 9…”

Clinical application of flow cytometry in patients with unexplained cytopenia and suspected myelodysplastic syndrome: A report of the European LeukemiaNet International MDS‐Flow Cytometry Working Group

“…An integrated FCM ( i FS) comprising the Ogata score with additional defined dysplastic features of the immature, maturing granulocytic and monocytic compartments as well as erythroid cell analysis can now be derived (Cremers et al, 2017). In this issue of Cytometry Part B Clinical Cytometry, Oelschlaegel et al, show that the i FS is currently the best scoring system for MDS diagnosis with respect to diagnostic accuracy (Oelschlaegel et al, 2021). Analysis of megakaryocytes in FCM encounters technical challenges due to their size, scarcity and fragility and the megakaryocytic lineage is therefore best assessed by cytomorphology in combination with histology.…”

Erythroid side scatter: A parameter that improves diagnostic accuracy of flow cytometry myelodysplastic syndrome scoring

“…Provision of a flow cytometry (FCM) myelodysplastic syndrome (MDS)‐score is part of the diagnostic work‐up for suspected MDS (Goel & Hasserjian, 2020; Swerdlow et al, 2018; Valent et al, 2017). Several FCM‐based MDS‐scores have been described (see for example (Bento et al, 2017; Oelschlaegel et al, 2021; Porwit et al, 2014). Our centre applies a flow score in line with the integrated flow cytometry (iFC) score (Porwit et al, 2014; Westers et al, 2012; Westers et al, 2017), which has high diagnostic accuracy (Cremers et al, 2017; Oelschlaegel et al, 2021).…”

“…Several FCM‐based MDS‐scores have been described (see for example (Bento et al, 2017; Oelschlaegel et al, 2021; Porwit et al, 2014). Our centre applies a flow score in line with the integrated flow cytometry (iFC) score (Porwit et al, 2014; Westers et al, 2012; Westers et al, 2017), which has high diagnostic accuracy (Cremers et al, 2017; Oelschlaegel et al, 2021). The majority of the >20 parameters included in this assay measure the phenotype and light scatter properties of mono‐myeloid cells.…”