International MDS risk analysis workshop (IMRAW)/IPSS reanalyzed: Impact of cytopenias on clinical outcomes in myelodysplastic syndromes

Abstract

The International Prognostic Scoring System (IPSS) was created for evaluating clinical outcomes of patients with myelodysplastic syndromes (MDS). We evaluated the depth of cytopenias to determine whether this parameter could further refine the prognostic ability of the IPSS. Correlation was determined between the depth of cytopenias in 816 patients from the International MDS Risk Analysis Workshop database and patients' clinical features. Univariate analyses of hemoglobin (Hb), absolute neutrophil count, and platelet depth levels were assessed relative to the IPSS risk groups, refined French-American-British categories, cytogenetic groups, bone marrow blast percentage (%), age groups, overall survival (OS), and time to evolution of acute myeloid leukemia (AML). Multivariate analysis of different cytopenic levels was performed to determine whether depth of cytopenias was prognostically additive to the IPSS. All cytopenic categories had statistically significant rank correlations with IPSS, bone marrow blast %, and refined French-American-British categories. In multivariate analysis, Hb levels had additive prognostic value to the IPSS for evaluation of OS, but not time to AML, with greatest prognostic value in Intermediate-1 and Intermediate-2 categories. In contrast, platelet or absolute neutrophil count levels alone or in combination lacked additive prognostic value to the IPSS regarding OS or time to AML evolution. The depth of Hb level per se at the time of diagnosis has additive predictive value to the IPSS for OS in the intermediate-risk groups. This information should prove useful for aiding therapeutic decision-making, prognostic classification, and designing clinical trials for patients with MDS. Am. J. Hematol. 83:765-770, 2008. V

Analyzing transformation of myelodysplastic syndrome to secondary acute myeloid leukemia using a large patient database

“…In addition, although not statistically significant in all risk groups, candidates for exclusion had lower mean blast percentages at MDS diagnosis. These factors positively correlate with improved prognosis and lower risk [37], and thus give biological support to the exclusion of these patients from the analysis (Table II).…”

Risk stratification using a new prognostic score for patients with secondary acute myeloid leukemia: results of the prospective AML96 trial

“…23,24 However, there are data indicating that platelet count levels alone lack additive prognostic information to the International Prognostic Scoring System (IPSS) regarding OS or time into AML evolution. 25 In AML, the impact of the platelet count on OS for adult patients up to 60 years of age harboring aberrations of chromosome band 11q23 has been published recently. In this study, a low platelet count (p50 Gpt/l) was found to negatively impact OS in the whole-patient cohort.…”

Prognostic relevance of anemia in myelodysplastic syndromes

“…In conclusion, the study of Kao et al [10] substantiates the observation that anemia is one the most important prognostic factors in myelodysplastic syndromes, and this observation should be used to guide clinical decision regarding therapeutic modalities and the timing of intervention.…”

“…As Kao et al [10] underscore, the severity of anemia likely reflects inherently poorer marrow function. In addition, chronic anemia is known to be associated with increased mortality and morbidity per se in community-dwelling older adults and patients with chronic heart failure [11], primarily because lower hemoglobin is associated with greater functional impairment and worse exercise capacity [12].…”

“…In this issue, Kao et al [10] report on an interesting study performed using the original IMRAW database. The aim of this study was to determine whether different degrees of anemia, thrombocytopenia, and neutropenia were of additional prospective prognostic value for the IPSS [6].…”