文章：

原发性骨髓增生异常综合征中淋巴细胞减少、单核细胞减少及淋巴细胞与单核细胞比值预后的相关性：889例患者单中心经验

Prognostic relevance of lymphocytopenia, monocytopenia and lymphocyte-to-monocyte ratio in primary myelodysplastic syndromes: a single center experience in 889 patients

原文发布日期：2017-03-31

DOI: 10.1038/bcj.2017.30

类型: Original Article

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英文摘要：

Current prognostic models for myelodysplastic syndromes (MDS), including the Revised International Prognostic Scoring System (IPSS-R), do not account for host immunity. We retrospectively examined the prognostic relevance of monocytopenia, lymphocytopenia and lymphocyte-to-monocyte ratio (LMR) in a cohort of 889 patients with primary MDS. After a median follow-up of 27 months, 712 (80%) deaths and 116 (13%) leukemic transformation were documented. In univariate analysis, subnormal absolute lymphocyte count (ALC) <0.9 × 109/l; P=0.001), ALC<1.2 × 109/l (P=0.0002), subnormal absolute monocyte count (AMC) <0.3 × 109/l (P=0.0003), LMR (P⩽0.0001) and LMR⩾5 (P=0.03) were all associated with inferior overall survival. In multivariable analysis that included other risk factors, significance was retained for LMR (P=0.02) and became borderline for ALC <1.2 × 109/l (P=0.06). Analysis in the context of IPSS-R resulted in P-values of 0.06 for ALC<1.2 × 109/l, 0.7 for monocytopenia and 0.2 for LMR. Leukemia-free survival was not affected by ALC, AMC or LMR. The observations from the current study suggest a possible detrimental role for altered host immunity in primary MDS, which might partly explain the therapeutic benefit of immune-directed therapy, including the use of immune modulators; however, IPSS-R-independent prognostic value for either ALC or AMC was limited.

摘要翻译： 

目前用于骨髓增生异常综合征（MDS）的预后模型（包括修订版国际预后评分系统IPSS-R）未考虑宿主免疫因素。我们回顾性分析了889例原发性MDS患者队列中单核细胞减少、淋巴细胞减少及淋巴细胞与单核细胞比值（LMR）的预后意义。中位随访27个月后，记录到712例（80%）死亡和116例（13%）白血病转化。单变量分析显示，低于正常的绝对淋巴细胞计数（ALC<0.9×10⁹/L；P=0.001）、ALC<1.2×10⁹/L（P=0.0002）、低于正常的绝对单核细胞计数（AMC<0.3×10⁹/L；P=0.0003）、LMR（P⩽0.0001）及LMR⩾5（P=0.03）均与较差的总生存期相关。在多变量分析中（包含其他风险因素），LMR保持显著意义（P=0.02），而ALC<1.2×10⁹/L处于临界意义（P=0.06）。在IPSS-R框架下的分析显示，ALC<1.2×10⁹/L的P值为0.06，单核细胞减少为0.7，LMR为0.2。无白血病生存未受ALC、AMC或LMR影响。本研究提示改变的宿主免疫力在原发性MDS中可能具有不利影响，这或许部分解释了免疫导向疗法（包括免疫调节剂使用）的治疗获益；然而，ALC或AMC独立于IPSS-R的预后价值有限。

原文链接：

Prognostic relevance of lymphocytopenia, monocytopenia and lymphocyte-to-monocyte ratio in primary myelodysplastic syndromes: a single center experience in 889 patients