ORIGINAL ARTICLE The prognostic value of circulating myeloblasts in patients with myelodysplastic syndromes Vu H. Duong 1 & Eric Padron 2 & Najla H. Al Ali 2 & Jeffrey E. Lancet 2 & Jeff Hall 3 & Brian Kwok 3 & Ling Zhang 4 & Pearlie K. Epling-Burnette 5 & Alan F. List 2 & Rami S. Komrokji 2 Received: 2 September 2017 /Accepted: 13 November 2017 # Springer-Verlag GmbH Germany, part of Springer Nature 2017 Abstract The prognostic value of peripheral blasts (PB) is not well-studied in patients with myelodysplastic syndromes (MDS). We evaluated the impact of PB on overall survival (OS) and transformation to acute myeloid leukemia (AML) in a large cohort. The MDS database at the Moffitt Cancer Center was retrospectively reviewed to identify patients with ≥ 1% PB (PB-MDS) and those without PB (BM-MDS). We also assessed the correlation between PB and gene mutations. One thousand seven hundred fifty-eight patients were identified, among whom 13% had PB near the time of diagnosis. PB-MDS patients were more likely to be younger with trilineage cytopenia, complex karyotype, higher-risk disease, transfusion dependence, and therapy-related MDS. The rate of AML transformation was 49 vs. 26% (p <0.005) and median OS was 16.5 vs. 45.8 months (p < 0.005) in the PB- MDS and BM-MDS groups, respectively. In Cox regression analysis, the presence of PB was an independent prognostic covariate for OS, HR 1.57 (95% CI 1.2–2). Among 51 patients with an available gene panel, the rate of ≥ 1 gene mutation in the PB-MDS group (n =4) was 100% compared to 81% in the BM-MDS group (n = 47). The presence of PB in MDS is an adverse independent prognostic variable that refines prognostic discrimination. Keywords Myelodysplastic syndrome . Anemia . Refractory . With excess of blasts . Leukemia . Myeloid . Prognosis . Retrospective studies Introduction Myelodysplastic syndromes (MDS) are a heterogeneous group of hematopoietic malignancies characterized by cyto- logic atypia, peripheral blood cytopenias, and an increased risk of progression to acute myeloid leukemia (AML). Medical management and selection of appropriate therapy in patients with MDS is predicated on accurate risk stratification. Several prognostic scoring systems have been developed and validated, but the most widely used systems include the International Prognostic Scoring System (IPSS) [1], the Revised International Prognostic Scoring System (IPSS-R) [2], and the Global MD Anderson Scoring System (MDA) [3]. These models take into account a variety of patient and disease characteristics including bone marrow blasts, karyo- type, and the number and depth of cytopenias. Patients with lower-risk disease have a median survival measured in years; thus, treatment is largely supportive with a goal of decreasing transfusion need and alleviating symptoms. In contrast, pa- tients with higher-risk disease have a median survival mea- sured in months and therefore, treatment is aimed at altering the natural history of disease and improving overall survival. Additional factors that independently affect outcomes of patients with MDS include presence of specific molecular mutations [4, 5], comorbid conditions/poor performance status [6, 7], serum albumin level [8], serum ferritin level [9], presence of bone marrow fibrosis [10], degree of eosinophilia and baso- philia [11], β2 microglobulin level [12, 13], and World Health * Vu H. Duong vduong@umm.edu 1 University of Maryland School of Medicine and Greenebaum Comprehensive Cancer Center, 22 S. Greene Street, S9D04B, Baltimore, MD 21201, USA 2 Department of Malignant Hematology, H Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA 3 Genoptix Medical Laboratory, Carlsbad, CA, USA 4 Hematopathology and Laboratory Medicine, H Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA 5 Immunology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA Annals of Hematology https://doi.org/10.1007/s00277-017-3186-4