Distinct Clinical and Experimental Characteristics in the Patients Younger than 60 Years Old with Myelodysplastic Syndromes

Abstract

Myelodysplastic syndromes (MDS) mainly occur in elderly individuals in Western countries. However, MDS is commonly found in young individuals (<60 years) in Asia. The reason for the high incidence in younger individuals is still unclear, and the differences in disease features between young and elderly patients with MDS have been not well recognized. To explore these issues, in this study, we analyzed the clinical and experimental characteristics of MDS in the patients younger and older than 60 years old and characterized the potential age-associated differences. The results showed that over half of the patients with MDS (61.9%) were younger than 60 years old upon the first diagnosis. The younger patients were more likely to be female, who have lower risk and less advanced MDS. The occurrence of trisomy 8 and bone marrow failure were more frequent in the younger patients than the older ones. The marrow CD34+ cells in the younger patients showed lower proliferation and higher apoptosis in comparison with that in the older ones. Obvious amplification of T cells and low CFU formation could be found in the younger patients. CFU formation was significantly increased in the younger patients after the removal of activated T cells. In addition, the younger patients had a lower frequency of p15INK4B methylation, longer survival expectancy and less AML transformation. In summary, the younger patients with MDS in China may show more benign disease features than the older ones. Enhanced immunological response may be involved in the pathogenesis of MDS in the patients younger than 60 years.

IPSS-M has greater survival predictive accuracy compared with IPSS-R in persons ≥ 60 years with myelodysplastic syndromes

“…Hence our patients were segregated into two cohorts using the cut-off age of 60 years depending on UN and WHO recommendations 22,23 . The result highlighted that prognosis was more favorable in younger patients compared with older ones which is consistent with other reports 17,18,20 . The disparity in survival largely resulted from the elderly's comorbidities.…”

“…Although Kuendgen et al 18 held the view that younger MDS patients were not signi cantly different compared with older ones. Other studies indicated that younger patients with MDS represented unique clinical and biological features and different prognosis 17,[19][20][21] . Therefore, we expanded our analyses to nd whether the genomic-clinical risk model derived from older patients had different performance in different age cohorts.…”

Are myelodysplastic syndromes underdiagnosed in Poland? A report by the Polish Adult Leukaemia Group

“…The respective indices for septuagenarians were 16.57 (14.17–19.37) vs. 3.57 (2.73–4.68) and 39.47 (35.67–43.68) vs. 18.88 (16.79–21.22) translating into ratios 4.64 and 2.09, and for octogenarians and older 28.63 (24.03–34.11) vs. 6.16 (4.8–7.9) and 88.41 (80.01–97.68) vs. 19.87 (17.3–22.82), translating to ratios 4.65 and 4.45. Interestingly, in younger patients, prevalence rates were higher in females, which stays in line with other reports focusing on younger patients, mostly under 50 yr of age .…”

Asian Population Is More Prone to Develop High-Risk Myelodysplastic Syndrome, Concordantly with Their Propensity to Exhibit High-Risk Cytogenetic Aberrations

“…By contrast, the median age in China and Japan is earlier than that of Western countries, ranging from 62–76 years old [ 17 , 18 ]. Punctually, a median age of 57 years old has been once reported in a Chinese study [ 21 ], and another Chinese report from 2013 showed that over half of the patients with MDS (61.9%) were younger than 60 year-old at the first diagnosis [ 22 ]. By contrast, about 10% of the patients were younger than 50 years of age in a German study from 2011 [ 23 ].…”