Evaluation of the prognostic relevance of L-selectin and ICAM1 expression in myelodysplastic syndromes

Objectives: An aberrant pattern of expression of L-selectin and intercellular adhesion molecule 1 (ICAM1) may characterise CD34(+) blast cells in myelodysplastic syndromes (MDS) and secondary acute myeloid leukaemia (sAML). Methods: In a three-colour flow cytometric assay, we evaluated the expression of L-selectin and ICAM1 on CD34(+) blast cells from the bone marrow (BM) of 66 MDS patients; for the purpose of comparison CD34(+) blast cells of 18 sAML and CD34(+) stem cells of 17 normal donors were also analysed. Results: The ratio of L-selectin/ICAM1 expression was identified as a parameter correlated with the percentage of BM blast infiltration and the time to leukaemic progression among MDS patients. In fact, the values of L-selectin/ICAM1 ratio were inversely correlated with the BM blast infiltration (r = -0.34, P = 0.004). Furthermore, MDS patients with a baseline ratio <1 had a higher leukaemic progression rate (41% vs. 19%, P = 0.008); the actuarial risk of disease progression for this subgroup of MDS patients was also higher (64% vs. 11% at 2 yr, P = 0.002). Furthermore, in two patients a decrease of the ratio was observed when overt leukaemic transformation occurred; conversely, restoration of a normal ratio was observed in two patients after a chemotherapy-induced remission. Conclusion: (i) L-selectin is defective in the stem cell compartment of MDS and sAML, whereas ICAM1 is overexpressed; (ii) the ratio of their expression has a prognostic role; and (iii) a ratio < 1 significantly predicts progression to overt leukaemia in MDS patients.