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. 2025 May 28;6(3):e70059.
doi: 10.1002/jha2.70059. eCollection 2025 Jun.

Flow Cytometry Analysis of Mesenchymal Stem Cells: A Predictive Biomarker for Leukemia Transformation in Myelodysplastic Syndrome

Mireia Atance  1 , Cristina Serrano  1 , Carlos Soto  1 , Juan Manuel Alonso-Domínguez  1   2 , Carlos Blas  1 , Raquel Mata  1 , Tamara Castaño  1 , Sara Perlado  1 , Teresa Arquero  1 , Jose Luis López-Lorenzo  1 , M Ángeles Pérez  1 , Belen Rosado  3 , Rafael Martos  4 , Ana Rio-Machin  2   5 , Pilar Llamas-Sillero  1   2 , Rocio N Salgado  1 , Juana Serrano-López  2
Affiliations

Flow Cytometry Analysis of Mesenchymal Stem Cells: A Predictive Biomarker for Leukemia Transformation in Myelodysplastic Syndrome

Mireia Atance et al. EJHaem. .

Abstract

Objective: This study evaluates the prognostic value of bone marrow-derived mesenchymal stem cells (MSCs) in predicting the progression of Myelodysplastic Syndrome (MDS) to Acute Myeloid Leukemia (AML).

Methods: MSC-like cells were analyzed using flow cytometry in a cohort of 49 MDS patients, including transformed and non-transformed groups.

Results: A non-hematopoietic CD13-bright cell population, enriched for MSC markers CD105 and CD90, was identified in 80% of patients at diagnosis. Elevated of these MSC-like cells were significantly associated with earlier progression to leukemia and reduced overall survival. Multivariate analysis confirmed MSC content as an independent predictor of leukemia transformation.

Conclusion: MSC-like cell content at MDS diagnosis may serve as a novel biomarker of predicting malignant transformation to AML. Further validation in larger cohorts and better phenotypic characterization of this cell population are needed.

Trial registration: The authors have confirmed clinical trial registration is not needed for this submission.

Keywords: MDS; biomarkers; flow cytometry; mesenchymal stem cells; secondary AML.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Quantification and prognostic impact of MSC‐like cells in MDS. (A) Scatter plot with bar illustrating the percentage of MSC‐like content at diagnosis of NT (No Transformed, n = 19) and T (Transformed, n = 29) patients. The NT group shows significant lower percentage than T group. (B) Scatter plot with bar comparing MSC‐like content among three stages of the disease: dxMSC‐like (diagnosis), intMSC‐like (before transformation and after Aza treatment), and tMSC‐like (in the leukemia phase). A transient peak of MSC‐like cells is observed before AML progression. DxMSC‐like includes the content of MSC‐like cells at diagnosis of both NT and T patients. (C) Scatter plot with bar representation showing the percentage of intMSC‐like content in no‐Peak and Peak groups. The no‐Peak group includes patients without an increase in MSC‐like cells before AML transformation, while the Peak group includes patients with an observed increase in MSC‐like cells before transformation. (D) Scatter plot with bar representation depicting the time to secondary acute myeloid leukemia (sAML) progression (in months) for no‐Peak and Peak groups. (E, F) Kaplan‐Meier survival curves representing time to sAML transformation. These panels illustrate thelikelihood of progression to AML, based on the presence of MSC‐like cells at the time of diagnosis. Patients with high dxMSC‐like content have an early progression to sAML in the total cohort of patients (E) and in the T group (F). Values represent mean ± ES. * p < 0.05. Each black dot represents an individual data point.
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