Validation and Modeling of Flow Cytometric CD36 Coefficient of Variation Analysis in the Diagnosis of Lower-Risk Myelodysplastic Syndrome

Objective: Myelodysplastic syndrome (MDS) constitutes a group of clonal hematopoietic disorders in which flow cytometry plays a limited yet evolving role in diagnosis. Recent studies have identified the CD36 coefficient of variation (CV) as a potential marker of dyserythropoiesis. This study aimed to validate the diagnostic utility of the CD36 CV in a local cohort, establish control-based cut-off values, and assess the added value of the CD36 CV when integrated into the Ogata score for improved detection of lower-risk MDS. Materials and Methods: In this retrospective study, 82 patients who underwent bone marrow aspiration for unexplained cytopenia were analyzed using multiparametric flow cytometry, cytogenetics, and morphological assessment. CD36 CV values were obtained from erythroid precursors and diagnostic thresholds were determined based on the distribution of values in the control group. Diagnostic models included CD36 CV alone, a combined binary model with the Ogata score, and an expanded five-point scoring system. Results: CD36 CV values were numerically higher in patients with MDS (mean: 75.81) compared to the control group (mean: 65.84), although the difference was not statistically significant (p=0.099). For low-risk MDS, the 75 Conclusion: Incorporating the CD36 CV into flow cytometric evaluation enhances diagnostic specificity for lower-risk MDS without requiring additional antibody panels. This locally validated marker may improve diagnostic accuracy when combined with myelomonocytic immunophenotyping. Standardization across institutions remains necessary for broader applicability.