Low RPS14 Expression in MDS without 5q- Aberration Is Associated with Increased Apoptosis of Erythrocytes and Predicts Prolonged Survival and Possible Response to Lenalidomide in Lower-Risk Patients

Haploinsufficiency of the ribosomal protein S14 (RPS14) has been identified as a causal factor in 5q- syndrome. This study was carried out to investigate RPS14 expression in myelodysplastic syndrome (MDS) without 5q deletion and the role under-expressed RPS14 plays in pathogenesis and the prognosis and lenalidomide-response predicting of non-5q-MDS.

The expression level of RPS14 transcription was detected in 156 MDS patients without 5q-. The apoptosis index of bone marrow (BM) erythrocytes was also analyzed. Furthermore, patient prognosis with low or normal RPS14 expression was analyzed and the role of RPS14 expression in lenalidomide-response prediction was elevated.

The reduced expression of RPS14 occurred in 83 of 156 (53.2%) patients. Patients with RPS14 under-expression presented higher platelet counts in the peripheral blood compared to RPS14 normal patients (p=0.012). RPS14 expression status was inversely corrected with the apoptosis index of erythrocytes from BM (r=-0.54, p=0.013). Patients with low RPS14 expression have a higher two-year survival probability than normal RPS14 cases in the international prognosis scoring system (IPSS) lower-risk group (90.8% vs. 71.7%; p = 0.018). A multivariate analysis showed RPS14 expression status was an independent predictor for survival in lower-risk MDS patients without 5q deletion. Twelve patients were treated with lenalidomide. Five of seven patients achieved an erythroid response in the low RPS14 expression group (5/7, 71.4%), compared to zero responses in the five normal RPS14 patients (p=0.018).

Low RPS14 expression is common in MDS patients without 5q deletion and is associated with increased apoptosis of erythrocytes in lower-risk MDS. Additionally, low RPS14 predicts prolonged survival and possible response to lenalidomide in lower-risk MDS patients.

No relevant conflicts of interest to declare.