Hematology Laboratory, CHU Nantes, Germany.
Hematology Clinic, CHU Nantes, Germany.
Br J Haematol. 2018 Dec;183(5):736-746. doi: 10.1111/bjh.15626. Epub 2018 Nov 8.
The diagnosis of myelodysplastic syndromes (MDS) is often challenging, time- and resource-consuming. A thorough analysis of complete blood count (CBC) parameters could, however, help to screen for MDS among other causes of cytopenia. To test this hypothesis, 109 newly-diagnosed MDS patients and 399 cytopenic patients older than 50 years with confirmed absence of MDS were enrolled in a prospective study. Multiparametric analysis highlighted three CBC parameters that were significantly different between the two cohorts: mean corpuscular volume, absolute neutrophil count and median neutrophil complexity and width of dispersion of the events measured (Ne-WX), which were used to define an MDS-CBC score. This score enables the prediction of MDS with 86% sensitivity and 88% specificity. The MDS-CBC score excluded MDS in 89% of cytopenic controls. Moreover, high score values at MDS diagnosis significantly correlated with decreased event-free (P = 0·02) and overall survival (P = 0·01). The power of this score was confirmed in an independent validation cohort (MDS n = 34, cytopenic controls n = 28). The MDS-CBC score is an easy and fast tool to exclude or suspect MDS in unselected patients with cytopenia of unknown reasons at the time of analysis, by prompting blood smear examination. It may thus improve allocation of further MDS-specific work-up in patients with cytopenia at the time of CBC assessment.
骨髓增生异常综合征（MDS）的诊断往往具有挑战性，既耗时又耗资源。然而，对全血细胞计数（CBC）参数的全面分析有助于在其他血细胞减少症的病因中筛选 MDS。为了验证这一假设，我们对 109 例新诊断的 MDS 患者和 399 例年龄大于 50 岁且经证实无 MDS 的血细胞减少症患者进行了前瞻性研究。多参数分析突出了两组间有显著差异的三个 CBC 参数：平均红细胞体积、绝对中性粒细胞计数和中性粒细胞复杂性以及事件测量的分布宽度（Ne-WX）中位数，这些参数用于定义 MDS-CBC 评分。该评分可实现 86%的敏感性和 88%的特异性预测 MDS。该 MDS-CBC 评分排除了 89%的血细胞减少症对照组中的 MDS。此外，MDS 诊断时的高评分值与无事件生存（P=0.02）和总生存（P=0.01）显著相关。该评分的效能在独立验证队列（MDS 患者 n=34，血细胞减少症对照组 n=28）中得到了确认。MDS-CBC 评分是一种简便快速的工具，可通过提示血涂片检查，在分析时对原因不明的血细胞减少症患者排除或怀疑 MDS，从而改善对 CBC 评估时血细胞减少症患者的 MDS 特异性进一步检查的分配。
