Research progress on classification and prognostic stratification of myelodysplastic syndrome

Myelodysplastic syndrome (MDS) is a relatively common group of myeloid malignant clonal diseases in the blood system. Different types of MDS patients have different clinical manifestations and natural course, as well as the iterations of different classification systems and versions in history, resulting distress in diagnosis, classification and treatment options. With the advancement of molecular biology technology and the use of Lenalidomide, Luspatercept, Venetoclax and other drugs, the classification criteria and prognostic scoring system of myelodysplastic syndrome have been continuously refined in recent years. In the 2016 WHO classification criteria, a molecular-related classification criterion (SF3B1) was introduced for the first time, and 5q- was redefined, emphasizing the concept of driver mutation. The 2022 WHO classification standard has more prominent molecular biological characteristics based on the original, and the classification of SF3B1 and 5q- has also been retained in the 2022 WHO classification standard. A new molecular correlation classification standard (bi-TP53) has been added to the 2022 WHO classification standard to further improve the classification of MDS patients by clinicians and researchers, reflecting the new trend of future genomics research that guide the precision medicine treatment of MDS. At the same time, the prognostic scoring system for MDS patients is constantly being updated. Based on the Revised International Prognostic Scoring System (IPSS-R) for Myelodysplastic Syndromes proposed in 2012, the newly proposed Molecular International Prognostic Scoring System (IPSS-M) for myelodysplastic Syndrome introduces a new prognostic scoring system for MDS patients, the stratification of risk factors in MDS patients is more precise and individualized. With the improvement of molecular targeted drugs and testing technology, IPSS-M will continue to be updated. To this end, we will summarize the classification criteria of MDS in recent years, as well as the progress and clinical significance of the prognostic stratification system

Decreased FOXO1 Expression Is Correlated with Poor Prognosis in Myelodysplastic Syndromes

Myelodysplastic syndrome is one of the main hematological malignancies that threaten the health of the elderly. However, biomarkers which predict the progression and prognosis of MDS are still controversial and puzzling. FOXO1 gene plays an important role in a variety of intracellular functions, including tumor suppression and cellular immune regulation. However, there is no research report on the correlation between FOXO1 and the clinical features of MDS including immune environment. In this study, we observed that FOXO1 expression is associated with neutrophil count, blasts, chromosome and different MDS scoring systems. FOXO1 expression is closely related to MDS cell immune polarization, and the increase expression of FOXO1 is significantly related to the amplification of immune cell polarization ratio. In addition, FOXO1 expression is associated with progression-free survival and overall survival in MDS patients. Moreover, in a multivariate model FOXO1 low-expression was an independent predictor of poor survival in MDS. In summary, FOXO1 may play a candidate tumor suppressor in MDS, and FOXO1 is a useful independent prognostic predictor in MDS, and it may provide a candidate target therapy in future