Clinical Prognostic Factors for Survival and Risk of Progression to Acute Myeloid Leukemia in Patients With Myelodysplastic Syndromes With < 10% Marrow Blasts and Non-Unfavorable Cytogenetic Categories

Association between Transfusion Status and Overall Survival in Patients with Myelodysplastic Syndromes: A Systematic Literature Review and Meta-Analysis

“…Studies that recruited only patients with high-risk disease had a lower range of HRs in the multiple Cox regression analyses (1.04; 95% CI n.r. ; p = 0.85 and 1.9; 95% CI 1.4-2.6; p ≤ 0.0001) [7,23] than studies that recruited only patients with low-risk disease [HR range 1.548 (95% CI 1.092-2.195; p = 0.014) to 10.95 (95% CI 3.19-37.53; p < 0.001)] [6,24]. In 2 of the 3 high-risk studies, the HR was nonsignificant [7,25].…”

“…Only low- and all-risk subgroups were included in the analysis because none of the 3 studies that recruited patients with high-risk disease were eligible for inclusion due to: (1) an overlap of the patient cohort with other studies [23], (2) the multiple Cox regression analysis in Komrokji et al [7] had already corrected for transfusion status and (3) data were not reported for the univariate or multiple Cox regression analyses (table 4) [25.] Two of 10 studies [24,39] selected only patients with low-risk disease whereas the rest selected patients with any severity or risk disease. The meta-analysis showed that TI was associated with a 59% decrease in the risk of death compared with TD [HR 0.41; 95% credible interval (CrI) 0.29-0.56; fig.…”

“…Ten studies [6,9,19,24,38,39,40,41,42,43] were included in the meta-analysis of type A studies (regardless of risk category) reporting the multiple Cox regression analysis HR for the OS of TI patients compared with TD patients. Analyzed cohort size ranged from 63 [6] to 840 [40.]…”

Epigenetic therapy of myelodysplastic syndromes and acute myeloid leukemia

“…Lower-risk MDS (LR-MDS), resistant to erythropoiesis-stimulating agents, still represent a challenging setting, due to the lack of alternative treatments in cases requiring heavy transfusion support. The efficacy of azacitidine has been recently evaluated by the Spanish MDS Group (GESMD) in a retrospective cohort of 27 LR-MDS patients with adverse clinical features, including age above 60 years, hemoglobin below 10 g/dl, transfusion dependence at diagnosis, platelet below 50 10 9 /l, and 4-9% bone marrow blasts [7]. Overall response was 41%.…”

Overexpression of GYS1, MIF, and MYC Is Associated With Adverse Outcome and Poor Response to Azacitidine in Myelodysplastic Syndromes and Acute Myeloid Leukemia

“…Additional factors such as severity of cytopenias, age, transfusion dependency, and karyotype also help in the refinement of prognosis and on the use of individualized therapeutic strategies in MDS. [7][8][9][10] In AML patients, cytogenetic features, history of previous MDS, and a growing spectrum of molecular abnormalities are widely recognized as the most important prognostic factors. [11][12][13] Nevertheless, predictive markers, which could allow identifying patients with different chances of response to conventional and new approaches, are required to individualize therapeutic strategies, thus avoiding the exposure to drugs that are unlikely to benefit patients.…”