Keywords
acute leukemia
blast cells
hematopoiesis
microenvironment
azacitidine
VEGF
How to Cite
Abstract
Introduction. Vascular endothelial growth factor (VEGF) and its receptors (VEGFR) play a crucial role in the pathophysiology of myelodysplastic syndrome (MDS), promoting angiogenesis in the bone marrow and acting as an autocrine growth factor for abnormal cells.
Aim. To identify the prognostic role of serum VEGF concentration and evaluate clusters of variant progenitor cell activity in patients with MDS RAEB-II with different responses to treatment with hypomethylating drugs.
Materials and methods. A total of 26 patients with MDS RAEB-II treated with the hypomethylating agent azacitidine were examined. All patients were treated at the Department of Blood Diseases of the SI “NSCRMHO”. The diagnosis was established according to the FAB classification criteria.
Results. Before treatment with azacitidine in the group of patients with MDS RAEB-II during the stabilization period, the number of colonies was 9.0 ± 0.5 per 1×10⁵ myeloid cells. When stabilization was achieved, the number of colonies increased to 16.3 ± 1.2 per 1×10⁵ myeloid cells, which was 1.8 times higher than the initial value, but 1.2 times lower than the corresponding indicator in patients who achieved a complete/partial response. The concentration of VEGF in the serum of patients with MDS RAEB-II during the period of stabilization of the pathological process was 1.1 times higher compared to the initial value. In the group of patients with MDS RAEB-II who did not respond to azacitidine treatment, an increase in blast cells to 5.3 ± 0.5% in the myelogram and to 19.3 ± 2.6% in the bone marrow was recorded, which may indicate the transformation of MDS RAEB-II into AML.
Conclusions. Along with the improvement of peripheral blood parameters in the group of patients with MDS RAEB-II who achieved a positive result in treatment with hypomethylating drugs, a decrease in VEGF concentration was observed. In cell clusters of patients who did not respond to treatment, this may indicate pronounced dyshemopoiesis and impaired communication between hematopoietic stem cells and the microenvironment. The cluster/colony ratio in cell culture may serve as a prognostic criterion for the course of MDS at different stages of the disease.
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