Evaluation of a Bone Marrow Dysmyelopoiesis Immunophenotypic Index for the Diagnosis and Prognosis of Myelodysplastic Syndromes

The unique heterogenous landscape of myelodysplastic syndromes/neoplasms (MDS) has resulted in continuous redefinition of disease sub-entities, in view of the novel translational research data that have clarified several areas of the pathogenesis and the progression of the disease. The new international classifications (WHO 2022, ICC 2022) have incorporated genomic data defining phenotypical alterations, that guide clinical management of specific patient subgroups. On the other hand, for over a decade, multiparameter flow cytometry (MFC) has proven its value as a complementary diagnostic tool for these diseases and although it has never been established as a mandatory test for the baseline evaluation of MDS patients in international guidelines, it is almost universally adopted in everyday clinical practice for the assessment of suspected cytopenias through simplified scoring systems or elaborate analytical strategies for the detection of immunophenotypical dysplastic features in every hematopoietic cell lineage in the bone marrow (BM). In this review, we explore the clinically meaningful interplay of MFC data and genetic profiles of MDS patients, to reveal the currently existing and the potential future role of each methodology for routine clinical practice, and the benefit of the patients. We reviewed the existing knowledge and recent advances in the field and discuss how an integrated approach could lead to patient re-stratification and guide personalized management.

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Application of Pathomic Features for Differentiating Dysplastic Cells in Patients with Myelodysplastic Syndrome

Hong,

Jeong,

Park

et al. 2024

Bioengineering

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Myelodysplastic syndromes (MDSs) are a group of hematologic neoplasms accompanied by dysplasia of bone marrow (BM) hematopoietic cells with cytopenia. Recently, digitalized pathology and pathomics using computerized feature analysis have been actively researched for classifying and predicting prognosis in various tumors of hematopoietic tissues. This study analyzed the pathomic features of hematopoietic cells in BM aspiration smears of patients with MDS according to each hematopoietic cell lineage and dysplasia. We included 24 patients with an MDS and 21 with normal BM. The 12,360 hematopoietic cells utilized were to be classified into seven types: normal erythrocytes, normal granulocytes, normal megakaryocytes, dysplastic erythrocytes, dysplastic granulocytes, dysplastic megakaryocytes, and others. Four hundred seventy-six pathomic features quantifying cell intensity, shape, and texture were extracted from each segmented cell. After comparing the combination of feature selection and machine learning classifier methods using 5-fold cross-validation area under the receiver operating characteristic curve (AUROC), the quadratic discriminant analysis (QDA) with gradient boosting decision tree (AUROC = 0.63) and QDA with eXtreme gradient boosting (XGB) (AUROC = 0.64) showed a high AUROC combination. Through a feature selection process, 30 characteristics were further analyzed. Dysplastic erythrocytes and granulocytes showed lower median values on heatmap analysis compared to that of normal erythrocytes and granulocytes. The data suggest that pathomic features could be applied to cell differentiation in hematologic malignancies. It could be used as a new biomarker with an auxiliary role for more accurate diagnosis. Further studies including prediction survival and prognosis with larger cohort of patients are needed.

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Evaluation of a Bone Marrow Dysmyelopoiesis Immunophenotypic Index for the Diagnosis and Prognosis of Myelodysplastic Syndromes

Abstract: DMI represents an accurate quantification of dysmyelopoiesis and an effective stand-alone diagnostic test for MDS, facilitating FC analysis and daily clinical practice.

Cited by 3 publications

References 35 publications

Effect of Chinese medicine treatment based on pattern identification on cellular immunophenotype of myelodysplastic syndrome

Effect of Chinese medicine treatment based on pattern identification on cellular immunophenotype of myelodysplastic syndrome

Immunophenotyping myelodysplastic neoplasms: the role of flow cytometry in the molecular classification era

Application of Pathomic Features for Differentiating Dysplastic Cells in Patients with Myelodysplastic Syndrome

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