Myelodysplastic Syndromes Clinical Trial
— MPO-MDS-PILOTOfficial title:
Flow Cytometric Analysis of Peripheral Blood Neutrophil Myeloperoxidase Expression for Ruling Out Myelodysplastic Syndromes: A Pilot Diagnostic Accuracy Study
Verified date | September 2018 |
Source | University Hospital, Grenoble |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Observational |
Myelodysplastic syndromes (MDS) constitute a heterogeneous group of clonal bone marrow
neoplasms that predominate in the elderly, with a median age at diagnosis of 70 years. MDS
are characterized by peripheral blood cytopenia and morphologic dysplasia for one or more
hematopoietic cell lineage, reflecting ineffective hematopoiesis.
The diagnostic work-up of MDS includes a bone marrow aspirate and biopsy, which is an
invasive procedure, for cytomorphologic and cytogenetic evaluations. Because the prevalence
of disease is lower than 20% in subjects referred for suspected MDS, many patients are
exposed to unnecessary bone marrow aspiration-related discomfort and harms.
An objective assay is highly desirable for accurately ruling out MDS based on peripheral
blood samples, which may obviate the need for invasive bone marrow aspiration and biopsy in
patients with negative results.
Few studies have investigated the value of peripheral blood flow cytometric analysis for the
diagnosis of MDS and/or chronic myelomonocytic leukemia (CMML). Although promising, these
studies lacked replication of their results, used a case-control design, which was prone to
spectrum bias, or yielded imprecise diagnostic accuracy estimates due to relatively limited
sample sizes.
Anecdotal evidence supports the potential of flow cytometric analysis of peripheral blood
neutrophil myeloperoxidase expression for the diagnosis of MDS and CMML. Myeloperoxidase is
an enzyme synthetized during myeloid differentiation that constitutes the major component of
neutrophil azurophilic granules. Myeloperoxidase expression may reflect neutrophil
hypogranulation, which is a classical although subjective dysplastic feature of MDS. Flow
cytometric analysis of myeloperoxidase expression in bone marrow neutrophil granulocytes has
been used for discriminating low versus high grade MDS. Yet a study reporting on the accuracy
of flow cytometric analysis of peripheral blood neutrophil myeloperoxidase expression for the
diagnosis of MDS is still lacking, to our knowledge.
In this study, the investigators hypothesize that flow cytometric analysis of neutrophil
myeloperoxidase expression in peripheral blood may accurately rule out MDS and obviate the
need for bone marrow aspiration and biopsy, with sensitivity approaching 100%, in routine
practice.
In this observational diagnostic accuracy study, burden will be null for recruited patients.
No specific intervention is assigned to participants. All diagnostic testing, procedures, and
medication ordering are performed at the discretion of attending physicians. Flow cytometry
analysis of peripheral blood neutrophil myeloperoxidase expression will not require
additional blood sample. A test result will have no impact on patient management. No
follow-up visits are planned in this cross-sectional study.
Status | Completed |
Enrollment | 60 |
Est. completion date | September 6, 2018 |
Est. primary completion date | September 6, 2018 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 50 Years and older |
Eligibility |
Inclusion Criteria: - Age =50 years; - Clinical suspicion of myelodysplastic syndromes (MDS) and / or chronic myelomonocytic leukemia (CMML); - Peripheral blood cytopenia defined by hemoglobin concentration <10 g/dL, platelet count <100 x109/L, and/or absolute neutrophil count <1.8 x109/L. Exclusion Criteria: - History of or active documented MDS or CMML; - Admission to the intensive care unit; - Suspicion of hematological disease other than MDS requiring bone marrow aspirate and/or biopsy (i.e., acute leukemia,…); - Absolute neutrophil count <0.5 x109/L; - Not affiliated with a social security system; - Homelessness; - Incarcerated; - Inability to understand research information and/or to provide non-opposition, because of language restriction, dementia, or altered mental status; - Refusal to participate; - Previous enrollment in the study. |
Country | Name | City | State |
---|---|---|---|
France | Centre Hospitalier Universitaire Estaing | Clermont-Ferrand | |
France | Centre Hospitalier Universitaire Grenoble Alpes | Grenoble |
Lead Sponsor | Collaborator |
---|---|
University Hospital, Grenoble |
France,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Area under the Receiver Operating Characteristic (ROC) curve of neutrophil myeloperoxidase expression in peripheral blood | The primary outcome is the discrimination of the index test (i.e., flow cytometry analysis of neutrophil myeloperoxidase expression in peripheral blood) for the diagnosis of myelodysplastic syndromes (MDS) or chronic myelomonocytic leukemia (CMLL) quantified by the area under the ROC curve point estimate along with its 95% confidence interval. | Baseline | |
Secondary | Sensitivity point estimates (along with 95% confidence interval) of neutrophil myeloperoxidase expression in peripheral blood for the diagnosis of MDS or CMML | Baseline | ||
Secondary | Specificity point estimates (along with 95% confidence interval) of neutrophil myeloperoxidase expression in peripheral blood for the diagnosis of MDS or CMML | Baseline | ||
Secondary | Negative predictive value point estimates (along with 95% confidence interval) of neutrophil myeloperoxidase expression in peripheral blood for the diagnosis of MDS or CMML | Baseline | ||
Secondary | Positive predictive value point estimates (along with 95% confidence interval) of neutrophil myeloperoxidase expression in peripheral blood for the diagnosis of MDS or CMML | Baseline | ||
Secondary | Prevalence point estimate (along with 95% confidence interval) for alternate diagnosis established by bone marrow cytomorphology. | Baseline |
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