Prognostic evaluation of ALIP and CD34 immunostaining in IPSS-R subgroups of myelodysplastic syndromes.

In order to evaluate the prognostic value of abnormal localisation of immature precursors (ALIP) and CD34 immunostaining in myelodysplastic syndromes (MDS), bone marrow histopathological features in 187 MDS patients were retrospectively analysed and the prognostic significance of ALIP and CD34 immunostaining on overall survival (OS) and progression to leukaemia-free survival (PFS) in total patients and different Revised-International Prognostic Scoring System (IPSS-R) subgroups were evaluated. In univariate analysis, age ≥60, ALIP, ≥5% CD34+ cells, CD34+ clusters and IPSS-R subgroups were associated with shorter OS (p = 0.027, p < 0.0001, p < 0.0001, p < 0.0001, p < 0.0001, respectively) and PFS (p = 0.029, p = 0.006, p = 0.001, p < 0.0001, p < 0.0001, respectively). Haemoglobin level had a significant impact on OS (p < 0.0001) but not on PFS (p = 0.054). In multivariate analysis, ALIP, haemoglobin level, ≥5% CD34+ cells, CD34+ clusters and IPSS-R subgroups had independent influence on OS (p = 0.012, p < 0.0001, p = 0.010, p < 0.0001, p < 0.0001, respectively), while only CD34+ clusters and IPSS-R subgroups had independent influence on PFS (p < 0.0001, p = 0.016, respectively). In different IPSS-R subgroups, ALIP could maintain its prognostic impact in lower IPSS-R risk subgroups, while ≥5% CD34+ cells and CD34+ clusters had significant prognostic value in both lower and intermediate-higher IPSS-R risk subgroups. Therefore, CD34+ clusters showed more important prognostic impact on survival and progression to leukaemia.