Retrospective Analysis Of Characteristics Of Myelodysplastic Syndrome

Obiective Analysis of the clinical characteristics of MDS patients in our hospital,the features of diagnosis,differential diagnosis,classification and prognosis of MDS patients were discussed at the same time,to further analyze the probability of progression from MDS to AL?acute leukemia?.Methods Clinical data of MDS patients who were initially treated at the first affiliated hospital of Dalian Medical University from January 2010 to December 2017were collected.In this study,terms including sex,age,basic check,bone marrow aspiration and biopsies,chromosome tests,FISH detection,gene sequencing detection,diagnostic,classification,therapeutic regimen and survival time were analyzed.All the cases were diagnosed according to the 2016 World Health Organization classification.SPSS22 software was used to analyze the data,the effects of sex,age,WHO classification,chromosomal karyotype on the leukemia transformation rate were compared and analyzed,and P<0.05 was considered to be statistically significant.Results 1.A total of 176 MDS patients in this study met the diagnostic criteria,ofwhich 116 cases male and 60 cases female and the ratio of males to females was 1.93:1,and median age was 64.0?20-90?years old.The highest peak age was between 61.0 and70.0 years old.2.The dizziness and fatigue,a result of anemia mainly bothered the patients.52.84%of the patients were diagnosed with macrocytic anemia,and MCV median value was102.10 fL?71.70-129.30?,91.82%?101/110?had normal folic acid levels,and 73.21%?82/112?had normal vitamin B₁₂ levels.3.As for classification,MDS-MLD is a common subtype among these patients?42.61%?,followed by MDS-EB2?23.30%?,MDS-EB1?19.32%?,MDS-RS?12.50%?,MDS-SLD?1.70%?,and 5 q-?0.57%?.As far as prognostic risk categories were concerned,77.27%of the patients with relatively high risk group?intermediate risk,high risk and very high risk?and 22.63%of the patients with relatively low risk group?low risk and very low risk?according to IPSS-R?Revised International Prognostic Scoring System?,.For treatment,simple support therapy and immunoregulative therapy were the main regimes.4.The bone marrow smear hyperplasia was active in 78.98%?139/176?of the patients,and 98.86%?174/176?of the patients showed pathological hematopoiesis in bone marrow smear,and 81.82%?144/176?were in the second and above pathological hematopoiesis.The bone marrow biopsies hyperplasia was active in 54.35%?25/46?of the patients.The rate of chromosome abnormality was 51.14%?90/176?by chromosomal karyotype test,of which+8?9.66%?was the highest,followed by-7/7q-,-20/20q-,-Y,-5/5q-.The rate of chromosome abnormality was 55.56%?25/45?detected by FISH,of which+8?24.44%?is the highest,followed by-7,5q-,20q-.The combined detection rate was 51.70%.Genetic mutations were detected in all 10 patients received genetic test,and the genes with higher mutation frequencies were TET2,TP53,U2AF1and ASXL1.5.9 patients with antoimmune diseases were found in systemic lupus erythematosus?SLE?and rheumatoid arthritis.16?9.09%?patients transformed to acute myeloid leukemia?AML?,of which 43.75%transformed to acute monocytic leukemia?M₅?,31.25%transformed to M₂,25%transformed to M_6,the median progression time was 6.5?1-27?months.Single factor analysis showed that age,sex,WHO classification and karyotype chromosomal could affect the rate of progression from MDS to acute leukemia.6.Among the 176 patients,42?23.86%?were lost to follow-up and the median follow-up time was 11.5?1-88?months.A total of 134 patients were followed,of whom 30were in the relatively low-risk groups?extremely low-risk and low-risk?,the shortest survival time was 2 months,the longest survival time was 88 months,and the median survival time was 18 months.Compared with 104 patients who were in the relatively high-risk groups.the shortest survival time was 1 month,the longest survival time was84 months,and the median survival time was 10 months.Conclusion1.The myelodyspastic syndrome was a kind of heterogeneous disorder,anemia-associated problems being the most common reason for the hospital visit.2.Cytogenetic abnormality is more than 50%in MDS patients,Fish can increase abnormal detection rate.3.MDS patients may be associated with autoimmune diseases,of which systemic lupus erythematosus?SLE?and rheumatoid arthritis are the highest.4.Elderly,male,patients with complex chromosomal karyotypes and subtypes of MDS-EB were at high risk of developing acute myeloid leukemia during the course of the disease,with the median progression time was 6.5 months.5.The clinical prognosis of MDS patients was significantly different,and the survival time of the high-risk group was shorter than that of the low-risk group.