Clinical Analysis Of 239 Cases Of Myelodysplastic Syndrome

Objective:to investigate the clinical manifestations and laboratory characteristics of myelodyslastic syndrome(MDS)in our hospital,and compare it to other data,we analyzed 239 cases of myelodyslastic syndrome,in order to facilitate the early diagnosis and effective treatment.Materials and methods:239 patients initially treated from January 2012 to October 2016 in Shandong Provincial Hospital were enrolled and analyzed.All the cases were diagnosed by Wright-Giemsa stained morphology of bone marrow and peripheral blood smears and chromosome results according to the World Health Organization(WHO)classification.In this retrospective analysis,the sex,age,clinical manifestations,classification,prognostic risk categories,blood routine test,serum ferritin,folic acid and vitamin B12 tests,serum erythropoietin,bone marrow aspiration and biopsies as well as FISH and chromosome tests were analyzed.The data were analyzed by the SPSS software,and p<0.05 was considered statistically significant.Results:239 patients with MDS were analyzed,with 136 cases male and 103 cases female and a median age of 55.0 years old.All the patients had a line of blood cells below normal,with 3 lines of blood cells below normal being most common(56.49%)when they were initially diagnosed.The headaches,dizziness and fatigue,a result of anemia mainly bothered the patients.All the patients did the chromosome test,with 38.08%of them being abnormal.There were 40 cases of RCUD,15 cases of RARS,88 cases of RCMD,36 cases of RAEB-I,58 cases of RAEB-II,1 case of MDS-U,1 case of 5q-syndrome according to the 2008 WHO classification.There were not significantly different correlation between MDS classification and the age,white blood cell count,red blood cell count,hemoglobin level,platelet count and neutrophil count,the bone marrow proliferation activity,the chromosome abnormality rate,the bone marrow proliferation activity in biopsy samples and FISH abnormality rate.As far as prognostic risk categories were concerned,there were no patients with very low risk,47 patients with low risk,81 patients with intermediate risk,63 patients with high risk and 48 patients with very high risk according to IPSS-R.The white blood cell count,red blood cell count,hemoglobin level,platelet count,neutrophil count the bone marrow proliferation activity and the chromosome abnormality rate were statistically significant between different prognostic risk categories,while age,the bone marrow proliferation activity in biopsy samples and FISH abnormality rate not statistically significant.The higher risk group the MDS patients were in,the more likely their chromosome abnormalities were detected.MDS patients received individualized treatment,including anti-infection,transfusions,hematopoiesis stimulants,iron chelation,immunoregulation and immunosuppression theraties as well as high intensity treatment options consisting of decitabine,chemotherapy and hematopoietic stem cell transplantation.There were 57 patients receiving high intensity treatmen(23.85%),of which 6 patients received allogeneic hematopoietic stem cell transplantation.Prior to hematopoietic stem cell transplantation,decitabine bridging therapy may enhance the effectiveness of transplantation,and this new treatment needs to be deeply investigated.Conclusion:The myelodysplastic syndrome is a kind of heterogeneous clonal hematopoietic stem cell disorder,mainly seen in elderly people.There were no specific manifestations in MDS patients,and anemia,bleeding and infection bothered them most,while anemia-associated problems being the most common reason for the hospital visit.All the initially diagnosed patients should complete the thorough tests to clear the diagnosis,classification and prognostic risk category.There were not significantly different correlation between MDS classification and the age,white blood cell count,red blood cell count,hemoglobin level,platelet count and neutrophil count,the bone marrow proliferation activity,the chromosome abnormality rate,the bone marrow proliferation activity in biopsy samples and FISH abnormality rate.The white blood cell count,red blood cell count,hemoglobin level,platelet count,neutrophil count the bone marrow proliferation activity and the chromosome abnormality rate were statistically significant between different prognostic risk categories,while age,the bone marrow proliferation activity in biopsy samples and FISH abnormality rate not statistically significant.They were risk-classified mainly according to IPSS-R and choose to receive individualized treatment.The hematopoietic stem cell transplantation was the only treatment option that had the potential to cure MDS.Prior to hematopoietic stem cell transplantation,decitabine bridging therapy may enhance the effectiveness of transplantation.