ORIGINAL ARTICLE
Open Access

Inflammatory Cytokine Profiles and Treatment Response in Patients with Myelodysplastic Syndromes

Wei Zhang1, Li-Mei Chen ORCID 2

1Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
2Department of Hematology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
DOI: 10.18081/ajbm.2025.4.416

Publication History: Received 01 October 2025, Revised 30 October 2025, Accepted 18 November 2025, Available online 17 December 2025
Copyright: © 2025 Chen, et al. This is an open-access article under a Creative Commons license (CC BY 4.0).
Crossmark logo

ABSTRACT

Background

Myelodysplastic syndromes (MDS) are clonal hematopoietic disorders characterized by ineffective hematopoiesis, cytopenia, and a variable risk of progression to acute myeloid leukemia. Increasing evidence suggests that immune dysregulation and chronic inflammation play an important role in MDS pathogenesis; however, the clinical relevance of inflammatory cytokine profiles in predicting treatment response remains insufficiently defined, particularly in Chinese patient populations

Methods

Myelodysplastic syndromes (MDS) are clonal hematopoietic disorders characterized by ineffective hematopoiesis, cytopenias, and a variable risk of progression to acute myeloid leukemia. Increasing evidence suggests that immune dysregulation and chronic inflammation play an important role in MDS pathogenesis; however, the clinical relevance of inflammatory cytokine profiles in predicting treatment response remains insufficiently defined, particularly in Chinese patient populations.

Results

A total of 186 patients were included. Elevated baseline levels of TNF-α and IL-6 were significantly associated with higher disease risk, increased bone marrow blast percentage, and inferior treatment response. Patients with lower TNF-α levels demonstrated significantly higher response rates compared with those with elevated TNF-α. High IL-6 expression was associated with reduced overall survival, with early and persistent separation of survival curves. In multivariable analyses, TNF-α and IL-6 remained independent predictors of treatment response after adjustment for age, disease risk category, and treatment modality.

Conclusion

Inflammatory cytokine profiles, particularly TNF-α and IL-6, are closely associated with treatment response, disease burden, and survival in Chinese patients with MDS. These findings support the clinical relevance of immune dysregulation in MDS and suggest that cytokine profiling may complement existing risk stratification models to guide more personalized therapeutic strategies.

Keywords: Myelodysplastic syndromes; Inflammatory cytokines; TNF-α; IL-6; Treatment response

Recommended Citation

Zhang W, Chen L. Inflammatory Cytokine Profiles and Treatment Response in Patients with Myelodysplastic Syndromes. Advanced Journal of Biomedicine & Medicine. 2025;13(4):416-431. doi:10.18081/ajbm.2025.4.416

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

References

  1. Adès L, Itzykson R, Fenaux P. Myelodysplastic syndromes. Lancet. 2014;383(9936):2239–2252. doi:10.1016/S0140-6736(13)61901-9
  2. Greenberg PL, Tuechler H, Schanz J, et al. Revised international prognostic scoring system for myelodysplastic syndromes. Blood. 2012;120(12):2454–2465. doi:10.1182/blood-2012-03-420489
  3. Fenaux P, Mufti GJ, Hellström-Lindberg E, et al. Efficacy of azacitidine compared with conventional care regimens. Lancet Oncol. 2009;10(3):223–232. doi:10.1016/S1470-2045(09)70003-8
  4. Platzbecker U. Treatment of MDS. Hematology Am Soc Hematol Educ Program. 2019;2019(1):462–469. doi:10.1182/hematology.2019000038
  5. Kitagawa M, Saito I, Kuwata T, et al. Overexpression of tumor necrosis factor-alpha in bone marrow of patients with MDS. Blood. 1997;90(11):4180–4186.
  6. Parker JE, Mufti GJ, Rasool F, et al. The role of apoptosis in the pathogenesis of MDS. Br J Haematol. 2000;111(2):510–519. doi:10.1046/j.1365-2141.2000.02380.x
  7. Epling-Burnette PK, Bai F, Wei S, et al. Reduced STAT3 signaling in MDS contributes to increased apoptosis. Blood. 2007;109(10):4385–4395. doi:10.1182/blood-2006-08-040691
  8. Kornblau SM, McCue D, Singh N, et al. Recurrent expression signatures of cytokines in MDS. Leukemia. 2010;24(6):1213–1220. doi:10.1038/leu.2010.77
  9. Tobiasson M, McLornan DP, Karimi M, et al. Immune dysregulation in MDS. Leukemia. 2017;31(9):1938–1948. doi:10.1038/leu.2017.79
  10. Basiorka AA, McGraw KL, De Ceuninck L, et al. The NLRP3 inflammasome functions in MDS. Leukemia. 2016;30(5):1182–1191. doi:10.1038/leu.2016.20
  11. Maratheftis CI, Andreakos E, Moutsopoulos HM, Voulgarelis M. Toll-like receptor signaling in MDS. Leukemia. 2018;32(4):929–939. doi:10.1038/leu.2017.320
  12. Steensma DP. Myelodysplastic syndromes: diagnosis and treatment. J Clin Oncol. 2018;36(9):845–853. doi:10.1200/JCO.2017.76.2070
  13. Wu L, Wang X, Zhang Y, et al. Clinical features of MDS in Chinese patients. Ann Hematol. 2016;95(4):617–624. doi:10.1007/s00277-015-2587-0
  14. Xu F, Wu L, He Q, et al. Distinct mutational patterns in Chinese MDS patients. Blood Cancer J. 2017;7(3):e529. doi:10.1038/bcj.2017.10
  15. Papaemmanuil E, Gerstung M, Malcovati L, et al. Somatic mutation landscape of MDS. Blood. 2013;122(22):3616–3627. doi:10.1182/blood-2013-07-518886
  16. Haferlach T, Nagata Y, Grossmann V, et al. Landscape of genetic lesions in MDS. N Engl J Med. 2014;370(26):2549–2560. doi:10.1056/NEJMoa1315353
  17. Sallman DA, DeZern AE, Garcia-Manero G, et al. Targeting inflammation in MDS. J Clin Oncol. 2020;38(17):1931–1941. doi:10.1200/JCO.19.03102
  18. Chen Y, Zhang Y, Zhao G, et al. Aging, inflammation, and hematologic malignancies. Aging Cell. 2020;19(6):e13129. doi:10.1111/acel.13129
  19. Jiang H, Hu Y, Liu X, et al. Real-world outcomes of HMAs in China. Front Oncol. 2021;11:673812. doi:10.3389/fonc.2021.673812
  20. Itzykson R, Thépot S, Quesnel B, et al. Prognostic factors for response to azacitidine. Blood. 2011;117(2):403–411. doi:10.1182/blood-2010-06-289280
  21. Vardiman JW, Thiele J, Arber DA, et al. WHO classification of MDS. Blood. 2009;114(5):937–951. doi:10.1182/blood-2009-03-209262
  22. Malcovati L, Hellström-Lindberg E, Bowen D, et al. Diagnosis and treatment of MDS. Haematologica. 2013;98(12):1875–1887. doi:10.3324/haematol.2013.092460
  23. Sekeres MA, Cutler C. How we treat MDS. Blood. 2014;123(6):829–836. doi:10.1182/blood-2013-08-496919
  24. Goldberg SL, Chen E, Corral M, et al. Incidence and outcomes of MDS. Leuk Res. 2010;34(8):976–981. doi:10.1016/j.leukres.2009.10.009
  25. Zhou J, Wang Y, Li J, et al. Immune microenvironment in MDS. Clin Transl Immunology. 2021;10(3):e1276. doi:10.1002/cti2.1276
  26. Heaney ML, Golde DW. Soluble cytokine receptors in hematologic disease. Blood. 1996;87(3):847–857.
  27. Della Porta MG, Tuechler H, Malcovati L, et al. Validation of IPSS-R. J Clin Oncol. 2015;33(21):2339–2346. doi:10.1200/JCO.2014.60.7371
  28. Nilsson L, Astrand-Grundström I, Anderson K, et al. Inflammatory signaling in MDS stem cells. Blood. 2010;116(23):4755–4764. doi:10.1182/blood-2010-02-269050
  29. Zhou L, Nguyen AN, Sohal D, et al. Cytokine dysregulation in MDS. Cancer. 2015;121(23):4071–4079. doi:10.1002/cncr.29643
  30. McLornan DP, List A, Mufti GJ. Applying precision medicine in MDS. Nat Rev Clin Oncol. 2018;15(8):498–510. doi:10.1038/s41571-018-0010-6
  31. Corey SJ, Minden MD, Barber DL, et al. Myelodysplastic syndromes: the complexity of stem-cell disorders. Nat Rev Cancer. 2007;7(2):118–129. doi:10.1038/nrc2043
  32. Chien KS, Lin J, Lin TL, et al. Immune dysfunction in Asian MDS patients. Int J Hematol. 2019;109(4):412–420. doi:10.1007/s12185-019-02612-5
  33. Deeg HJ, Sandmaier BM. Who is fit for stem cell transplantation in MDS? Blood. 2010;116(23):4762–4770. doi:10.1182/blood-2010-05-286278
  34. Kordasti S, Costantini B, Seidl T, et al. Deep immune profiling in MDS. Blood. 2016;128(2):203–214. doi:10.1182/blood-2016-01-694232
  35. Pang WW, Schrier SL, Weissman IL. Age-associated changes in hematopoiesis. Proc Natl Acad Sci USA. 2011;108(50):20012–20017. doi:10.1073/pnas.1116118108
  36. Westers TM, Cremers EM, Oelschlaegel U, et al. Immunophenotypic analysis in MDS. Leukemia. 2017;31(4):823–831. doi:10.1038/leu.2016.282
  37. He Q, Chen Y, Xu Z, et al. Cytokine expression and prognosis in MDS. Leuk Lymphoma. 2018;59(6):1415–1422. doi:10.1080/10428194.2017.1365849
  38. Bowen D, Culligan D, Jowitt S, et al. Guidelines for diagnosis and therapy of MDS. Br J Haematol. 2003;120(2):187–200. doi:10.1046/j.1365-2141.2003.04099.x
  39. List A, Dewald G, Bennett J, et al. Lenalidomide in MDS. N Engl J Med. 2006;355(14):1456–1465. doi:10.1056/NEJMoa061292

2025 Vol 13, Issue 4 Pages 416-431

Download article

PDF Download: 235

PDF (427.7 KB) XML (4.0 KB)

Cite this article

Zhang W, Chen L (2025). Inflammatory Cytokine Profiles and Treatment Response in Patients with Myelodysplastic Syndromes<br /> . Advanced Journal of Biomedicine & Medicine, 13(4), 416-431. https://doi.org/10.18081/ajbm.2025.4.416
Zhang W, Chen L. "Inflammatory Cytokine Profiles and Treatment Response in Patients with Myelodysplastic Syndromes<br /> ." Advanced Journal of Biomedicine & Medicine, vol. 13, no. 4, 2025, pp. 416-431. DOI: 10.18081/ajbm.2025.4.416.
Zhang W, Chen L. Inflammatory Cytokine Profiles and Treatment Response in Patients with Myelodysplastic Syndromes<br /> . AJBM. 2025;13(4):416-431. DOI: 10.18081/ajbm.2025.4.416. PMID: .
Zhang W, Chen L 2025, "Inflammatory Cytokine Profiles and Treatment Response in Patients with Myelodysplastic Syndromes<br /> ", Advanced Journal of Biomedicine & Medicine, vol. 13, no. 4, pp. 416-431.
@article{zhang2025, title={Inflammatory Cytokine Profiles and Treatment Response in Patients with Myelodysplastic Syndromes<br /> }, author={Zhang W, Chen L}, journal={Advanced Journal of Biomedicine & Medicine}, volume={13}, number={4}, pages={416-431}, year={2025}, doi={10.18081/ajbm.2025.4.416} }
TY - JOUR AU - Zhang W, Chen L TI - Inflammatory Cytokine Profiles and Treatment Response in Patients with Myelodysplastic Syndromes<br /> JO - American Journal of Biomedicine VL - 13 IS - 4 SP - 416-431 PY - 2025 DO - 10.18081/ajbm.2025.4.416 ER -
%0 Journal Article %A Zhang W, Chen L %T Inflammatory Cytokine Profiles and Treatment Response in Patients with Myelodysplastic Syndromes<br /> %J American Journal of Biomedicine %V 13 %N 4 %P 416-431 %D 2025 %R 10.18081/ajbm.2025.4.416 %M
Zhang W, Chen L (2025). Inflammatory Cytokine Profiles and Treatment Response in Patients with Myelodysplastic Syndromes<br /> . Advanced Journal of Biomedicine & Medicine, 13(4), 416-431. https://doi.org/10.18081/ajbm.2025.4.416

PlumX Metrics