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Current prognostic models for myelodysplastic syndromes (MDS), including the Revised International Prognostic Scoring System (IPSS-R), do not account for host immunity. We retrospectively examined the prognostic relevance of monocytopenia, lymphocytopenia and lymphocyte-to-monocyte ratio (LMR) in a cohort of 889 patients with primary MDS. After a median follow-up of 27 months, 712 (80%) deaths and 116 (13%) leukemic transformation were documented. In univariate analysis, subnormal absolute lymphocyte count (ALC) <0.9 × 10 9 /l;  P =0.001), ALC<1.2 × 10 9 /l ( P =0.0002), subnormal absolute monocyte count (AMC) <0.3 × 10 9 /l ( P =0.0003), LMR ( P ⩽0.0001) and LMR⩾5 ( P =0.03) were all associated with inferior overall survival. In multivariable analysis that included other risk factors, significance was retained for LMR ( P =0.02) and became borderline for ALC <1.2 × 10 9 /l ( P =0.06). Analysis in the context of IPSS-R resulted in  P -values of 0.06 for ALC<1.2 × 10 9 /l, 0.7 for monocytopenia and 0.2 for LMR. Leukemia-free survival was not affected by ALC, AMC or LMR. The observations from the current study suggest a possible detrimental role for altered host immunity in primary MDS, which might partly explain the therapeutic benefit of immune-directed therapy, including the use of immune modulators; however, IPSS-R-independent prognostic value for either ALC or AMC was limited.

blood cancer journal

Prognostic relevance of lymphocytopenia, monocytopenia and lymphocyte-to-monocyte ratio in primary myelodysplastic syndromes: a single center experience in 889 patients