Serum CD44 levels predict survival in patients with low-risk myelodysplastic syndromes

Loeffler-Ragg, J.; Germing, U.; Sperr, W.R.; Herrmann, H.; Zwierzina, H.; Valent, P.; Ulmer, H.; Stauder, R.

doi:10.1016/j.critrevonc.2010.05.008

« Previous Next »Critical Reviews in Oncology / Hematology
Volume 78, Issue 2 , Pages 150-161, May 2011

Serum CD44 levels predict survival in patients with low-risk myelodysplastic syndromes

J. Loeffler-Ragg
- Department of Internal Medicine I, Innsbruck Medical University, Innsbruck, Austria
U. Germing
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University, Düsseldorf, Germany
W.R. Sperr
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Vienna Medical University, Vienna, Austria
H. Herrmann
- Ludwig Boltzmann Cluster Oncology, Vienna, Austria
H. Zwierzina
- Department of Internal Medicine I, Innsbruck Medical University, Innsbruck, Austria
P. Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Vienna Medical University, Vienna, Austria
- Ludwig Boltzmann Cluster Oncology, Vienna, Austria
H. Ulmer
- Department of Biostatistics and Documentation, Innsbruck Medical University, Innsbruck, Austria
R. Stauder
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
- Corresponding author. Tel.: +43 512 504 23255.

Accepted 28 May 2010. published online 28 June 2010.

Abstract

Myelodysplastic syndromes (MDS) represent a heterogeneous group of clonal hematopoietic stem cell disorders that are preferentially diagnosed in the elderly. Aberrant expression of the adhesion receptor CD44 correlates with poor prognosis in various neoplasms. To evaluate the prognostic impact of CD44 in MDS serum levels of soluble CD44 standard (solCD44s) were measured in 130 MDS patients (median age 68 years) using an enzyme-linked immunosorbent assay (ELISA). solCD44s levels were significantly elevated in MDS patients as compared to those of healthy donors (p<0.001) and were found to correlate with distinct FAB and WHO subtypes. The highest levels of solCD44s were found in patients with CMML, in RAEB and in patients with MDS transformed into secondary acute myeloid leukaemia (AML). In univariate analysis elevated levels of solCD44s (cut-off level>688.5ng/ml) correlated significantly with shorter overall survival in MDS patients (12 versus 39 months; p<0.001). In multivariate analysis solCD44s displayed prognostic significance independent of the International Prognosis Scoring System (IPSS). To test for refined prognostication, IPSS risk groups were split into two separate categories based on the solCD44s levels. Using this approach, MDS patients with a shorter survival were identified both in the IPSS low-risk (p=0.037) and in the IPSS intermediate-1-risk group (p=0.015). The CD44s-adjusted IPSS defines a cohort of MDS patients with unfavorable prognosis, which might be helpful in risk stratification and in therapeutic algorithms.