The Clinical Significance of Tumor Associated Macrophages in Myelodysplastic Syndromes

Objective:

The purpose of this study is to investigate the relationship between the infiltration of tumor associated macrophages (TAMs) and the disease risk stratification and survival of patients with myelodysplastic syndrome (MDS) and to explore the role of TAMs in the clinical prognosis.

Methods:

We retrospectively collected and analyzed 115 patients initially diagnosed wih myelodysplastic syndromes from January, 2010 to July, 2017 in West China Hospital of Sichuan University. Both bone marrow biopsy specimens and clinical data of the patients enrolled were collected. All patients were assessed prognosis by international prognostic scoring system (IPSS). We quantified the involvement of macrophage (MΦ), alternatively activated macrophage (M2 MΦ) and classic activated macrophage (M1 MΦ) in bone marrow specimen by staining with anti-CD68 monoclonal antibody, anti-CD163 monoclonal antibody, and anti-iNOS monoclonal antibody respectively. Log-rank test was used to evaluate the difference of overall survival (OS) among different subgroups. Logistic regression was used to evaluate the effect of clinical parameters on patients' OS. Cox proportional-hazards models were used to estimate the independent risk factors influencing the prognosis of patients.

Results:

1 In the high risk group of MDS, the composition of CD163+MΦ was higher than that of the low risk group(p < 0.001). In the low risk group of MDS, the composition of iNOS+ MΦ was higher than that of the group with high risk(p < 0.001).

2 The median survival time and 3-year survival rate in the high CD163+MΦinfiltration group were significantly lower than those in the low infiltration group (13 months vs 43 months, 27% vs 64%, Log-rank test, P<0.001). The median survival time and 3-year survival rate in high iNOS+MΦ infiltration group were significantly higher than those in low infiltration group (42. 5 months vs 11 months, 65% vs 27% Log-rank test, P< 0.001).

3 According to the infiltration degree of iNOS+MΦ and CD163+MΦ, the M1 (iNOS^high/CD 163^low)and M2 TA(iNOS^low/CD163^high) MΦ were further distinguished (The median OS were 53m and 15m respectively, p< 0.001).

4 In multivariate analysis, high infiltration of CD163+MΦ and CD68+MΦ, low infiltration of iNOS+MΦ and low PLT level were independent risk factors for patients' OS .

Conclusion and Discuss:

The degree of bone marrow TAMs subtype infiltration in MDS patients was associated with disease risk group. CD163+M Φ was the main TAMs in the high risk group of MDS,while iNOS+M Φ was the main TAMs in the low risk group. There was a positive correlation between the infiltration of M1-TAMs and OS. On the contrary, there was a negative correlation between the infiltration of M2-TAMs and OS. Analyzing TAMs subsets in bone marrow of patients with MDS is helpful to evaluate disease risk and prognosis.

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