Validation and Modeling of Flow Cytometric CD36 Coefficient of Variation (CV) Analysis in the Diagnosis of Lower-Risk Myelodysplastic Syndromes

Myelodysplastic syndromes (MDS) are clonal hematopoietic disorders in which flow cytometry plays a limited yet evolving role in diagnosis. Recent studies have identified CD36 coefficient of variation (CV) as a potential marker of dyserythropoiesis. This study aimed to validate the diagnostic utility of CD36 CV in a local cohort, establish control-based cutoff values, and assess the added value of CD36 CV when integrated into the Ogata score for improved detection of lower-risk MDS. 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 was measured 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 Ogata score, and an expanded five-point scoring system. CD36 CV values were numerically higher in MDS patients (mean 75.81) compared to controls (mean 65.84), though not statistically significant (p=0.099). For low-risk MDS, the 75th percentage cutoff yielded 60% sensitivity and 80% specificity. Integration of CD36 CV into the Ogata score improved specificity from 33.3% to 80% at a ≥3-point threshold, with an AUC of 0.754 (p=0.003). Models using higher cutoffs demonstrated lower sensitivity. Incorporating CD36 CV into flow cytometric evaluation enhances diagnostic specificity for lowerrisk 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.