Back to Journals » Journal of Blood Medicine » Volume 8

Clinical, hematological, and cytogenetic profile of adult myelodysplastic syndrome in a tertiary care center

Authors Narayanan S

Received 30 November 2016

Accepted for publication 20 January 2017

Published 23 February 2017 Volume 2017:8 Pages 21—27

DOI https://doi.org/10.2147/JBM.S129111

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Sanjay Khandelwal

Peer reviewer comments 2

Editor who approved publication: Dr Martin Bluth

Santhosh Narayanan

Department of Medicine, Government Medical College, Kozhikode, Kerala, India

Background: Myelodysplastic syndrome (MDS), a disorder of clonal hematopoiesis, is an important clinical entity, but most of the studies available are conducted among the Western population. Its etiological factors and clinicohematological profile in the Indian population are quite diverse. The information regarding its prognostic factors and cytogenetics is very scarce.
Objectives: (1) To assess the clinicohematological profile, cytogenetics, prognostic factors, and outcome of MDS and (2) to study its progression to acute myeloid leukemia (AML) in the selected patients over the study period.
Methods: A prospective observational study was performed with patients from Department of Medicine and Hematology, Government Medical College, Kozhikode, who were diagnosed with MDS within the study period (from 1 January 2014 to 31 July 2015). Secondary causes of dysplasia were excluded. In possible cases, the international prognostic scoring system was followed. These patients were followed up for an additional 6 months to assess the progression of MDS to AML based on symptoms, signs, hemogram, or repeat peripheral smear/bone marrow studies.
Results: Of the 60 patients, 73% were aged >60 years. Disease was common in males, with a male:female ratio of 7:3. Thirty-five percent of the patients were working in agricultural and allied fields and had pesticide exposure. Patients with prior radiation exposure had significant association with adverse outcome. Fatigue was the prominent symptom and was reported by 90% of the patients. Blasts were >5% in peripheral smear; bone marrow cytopenia and dysplasia at the time of diagnosis had significant association with risk of transforming to AML. Refractory anemia (RA), observed in 22 patients, was the most common type of MDS. Most of the patients with RA with excess blasts type-1 and RA with excess blasts type-2 transformed to AML, and the association was statistically significant. Deletion of short arm of fifth chromosome (5q deletion) was detected in 11 patients. All of them showed good response to treatment with lenalidomide and had a favorable outcome.
Conclusion: This study highlights the various etiological factors, and the clinical profile of MDS seen in the Indian population. Cytogenetic analysis and application of the international prognostic scoring system has a significant bearing on the outcome, as exemplified by the response to lenalidomide in patients with 5q deletion. This study also indicates that proper diagnostic and prognostic assessment is necessary to institute appropriate therapeutic options.

Keywords: MDS, cytogenetics, AML, prognosis

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]

 

Other articles by this author:

Hypothermia due to limbic system involvement and longitudinal myelitis in a case of Japanese encephalitis: a case report from India

Narayanan S, Thulaseedharan NK, Subramaniam G, Panarkandy G, Shameer VK, Narayanan A

International Journal of General Medicine 2017, 10:125-129

Published Date: 12 April 2017

Pulmonary alveolar hemorrhage following thrombolytic therapy

Narayanan S, Thulaseedharan NK, Subramaniam G, Panarkandy G, Arathi N

International Medical Case Reports Journal 2017, 10:123-125

Published Date: 4 April 2017

The "black evil" affecting patients with diabetes: a case of rhino orbito cerebral mucormycosis causing Garcin syndrome

Narayanan S, Panarkandy G, Subramaniam G, Radhakrishnan C, Thulaseedharan NK, Manikath N, Ramaswamy S, Radhakrishnan S, Ekkalayil D

Infection and Drug Resistance 2017, 10:103-108

Published Date: 28 March 2017