Prognostic Value of HALP Score, Monocytopenia, Hypofibrinogenemia, and AST/ALT Ratio in Patients With Myelodysplastic Syndromes at Assiut University Hospital.

Frequently seen in advanced age, myelodysplastic syndromes (MDS) are a heterogeneous clonal stem cell disorders characterized by ineffective hematopoiesis and having a risk of progression to acute myeloid leukemia (AML). The clinical course of MDS varies considerably, and most patients cannot tolerate intensive treatment approaches due to their advanced age. Accurate diagnosis and reliable prognostic assessment are of critical importance for making individualized clinical decisions in patients with MDS(2). Therefore, prognostic parameters and/or prognostic scoring systems have been developed to distinguish between patient groups differing in median survival time. An ideal prognostic scoring system should contain merely independent prognostic parameters, and the limits of these parameters should be validated, easily identifiable at diagnosis, and cost-effective. The international prognostic scoring system (IPSS), the revised IPSS (IPSS-R), and the World Health Organization (WHO) prognostic scoring system [WPSS] are the most commonly utilized prognostic models (3,4). However, it is considered that many factors, except for the variables in these systems, may also affect the prognosis of MDS5. Immune response and Inflammatory cells have been defined as very important parameters in cancer survival rate(6). In several recent studies, peripheral blood cells, including absolute lymphocyte count (ALC), monocytes, and platelets (Plt), have been reported to be related to higher mortality rates in lymphoma patients(7,8 ) . In recent years, many combinations of infammatory parameters, such as neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and lymphocyte-monocyte ratio have been used to predict the prognosis in patients with oncological and hematological malignancies (9-11). Nutritional status has also been emphasized in various studies as an important factor affecting the prognosis(11-13). Previous studies have defined a new infammatory index called the hemoglobin, albumin, lymphocyte, and platelet (HALP) score, which is effective in the prognosis of those with kidney, bladder, stomach, small-cell lung, and prostate cancers(14-17). The HALP score is calculated using four laboratory markers (hemoglobin, albumin, lymphocyte, and platelet), which are the biomarkers of nutrition and Inflammation status. In the field of hematology, the prognostic efficiency of the HALP score has been evaluated in a limited number of studies, including in diffuse large B-cell lymphoma and multiple myeloma (18,19). Based on the literature, however, there are no studies evaluating the relationship between the HALP score and the prognosis of MDS patients. Also , numerous promising biomarkers have been evaluated as potential prognosis predictors for MDS. For instance, low absolute lymphocyte count (ALC) and absolute monocyte count (AMC) levels, decreased serum ApoA1 levels, as well as an increase in the number of mature monocytes in the bone marrow can predict poor prognosis in MDS.(6-9 )However, none of these markers have been adopted into IPSS-R. In recent years, it has also been reported that high FIB is a poor prognostic factor in some tumors.(10-12 )However, evidence of the role of FIB in MDS is lacking. In addition, AST/ALT ratio could be a simple and economic prognostic indicator for MDS and be used as a supplement to IPSS-R, especially when lacking of karyotype or mutation data.