Department of Hematology, Sixth Hospital affiliated to Shanghai Jiaotong University, Shanghai, China.
Hematol Oncol. 2010 Jun;28(2):98-103. doi: 10.1002/hon.907.
We studied the effects of the presence of the HLA-DR15 allele on the experimental and clinical features of myelodysplastic syndrome (MDS) by assessing the clinical data of 136 patients with MDS. We observed that the frequency of HLA-DR15 expression in MDS patients (38.7%) was significantly higher than that in the healthy controls (p < 0.01). We noted the following observations with regard to disease progression: None of the 46 HLA-DR15 positive patients with international prognostic scoring system (IPSS) scores <or=1 developed acute myeloid leukaemia (AML) during the follow-up period, while six of the 63 DR15-negative patients with the same IPSS score developed AML within a shorter follow-up period (p = 0.039). Furthermore, the incidence of poor chromosomal abnormalities, the percentage of patients with IPSS scores >or=1.5 and the presence of >or=5% blasts in the bone marrow in the DR15-positive patients were lower than the corresponding findings in the DR15-negative patients. In addition, we also recorded the following observations with regard to bone marrow (BM) failure: The bicytopenia/pancytopenia ratio in the DR15-positive patients was higher than that in the DR15-negative patients (92.4 vs. 78.3%; p = 0.029). The peripheral-neutrophil count and the platelet count in the DR15-positive patients were lower than those in the DR15-negative patients (p = 0.028 and p = 0.011, respectively). Moreover, hypocellularity was more easily detectable in the DR15-positive patients (26.4 vs. 16.9%). In addition, the BM CD4+ lymphocyte count and the CD4/CD8 ratio in the DR15-positive patients were higher than the corresponding values in the DR15-negative patients (p < 0.05 for both). However, there were no significant differences between the polarization of T-helper (T(h)) and T-cytotoxic (T(c)) cells and the cytokine levels in these two patient groups. We concluded that the presence of the HLA-DR15 allele is indicative of a genetic susceptibility to MDS and, the presence of the HLA-DR15 allele showed less association with disease progression and greater association with BM failure.
我们通过评估 136 例 MDS 患者的临床资料，研究了 HLA-DR15 等位基因的存在对 MDS 实验和临床特征的影响。我们观察到 MDS 患者 HLA-DR15 表达的频率（38.7%）明显高于健康对照组（p<0.01）。我们注意到疾病进展方面的以下观察结果：在国际预后评分系统（IPSS）评分<或=1 的 46 例 HLA-DR15 阳性患者中，无一人在随访期间发生急性髓系白血病（AML），而在具有相同 IPSS 评分的 63 例 DR15 阴性患者中，有 6 例在较短的随访期内发生 AML（p=0.039）。此外，DR15 阳性患者中不良染色体异常的发生率、IPSS 评分>或=1.5 的患者比例以及骨髓中>或=5%原始细胞的比例均低于 DR15 阴性患者。此外，我们还记录了骨髓（BM）衰竭方面的以下观察结果：DR15 阳性患者的双系/全血细胞减少症的比例高于 DR15 阴性患者（92.4%比 78.3%；p=0.029）。DR15 阳性患者的外周中性粒细胞计数和血小板计数低于 DR15 阴性患者（p=0.028 和 p=0.011）。此外，DR15 阳性患者更容易出现细胞减少症（26.4%比 16.9%）。此外，DR15 阳性患者的 BM CD4+淋巴细胞计数和 CD4/CD8 比值高于 DR15 阴性患者（p<0.05）。然而，这两组患者的 T 辅助（T(h)）和 T 细胞毒性（T(c)）细胞的极化以及细胞因子水平没有显著差异。我们得出结论，HLA-DR15 等位基因的存在表明 MDS 存在遗传易感性，HLA-DR15 等位基因的存在与疾病进展的相关性较小，与 BM 衰竭的相关性较大。
