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[Myelodysplastic syndromes. Clinico-pathologic analysis of 54 cases]
A Luraschi1, P Buscaglia, P Fedeli
1Divisione di Medicina, Ospedale di Omegna, Omegna.
Abstract:
For myelodysplastic syndromes (MDS) many scoring systems were developed to improve the prognostic stratification of patients.
Methods And Aim Of The Study:
We enrolled 54 primary MDS patients, having an advanced median age of 78.5 years, that discouraged the choice of aggressive treatments. Then, we employed only the Bournemouth score (without cytogenetic analysis), with the aim to identify the best predictor of death and of AML development.
Results:
Both for overall and leukemia-free analysis, shorter survival and faster development of AML were found in MDS patients with severe peripheral cytopenia, RAEB-T, major proportion of bone marrow blasts (over 20%) and with the higher Bournemouth score (i.e. 3-4). The multivariate analysis by the Cox's regression model showed that a high percentage of bone marrow blasts presented the best statistical significance.
Conclusions:
In our survey we confirmed the value of Bournemouth score in identifying those MDS patients presenting a greater risk of death and AML development. Moreover, a high percentage of bone marrow blasts rose as the best predictor of death and leukemic evolution. The kariotypic analysis, with a stronger prognostic power but also complex and expensive, was not performed in our elderly MDS patients, who were unable to tolerate aggressive treatments.
Insights
The Bournemouth score effectively predicts death and AML development in myelodysplastic syndromes (MDS) patients. High bone marrow blast percentage is the strongest indicator for these outcomes in elderly MDS.
Area of Science:
- Hematology
- Oncology
- Prognostic Biomarkers
Context:
- Myelodysplastic syndromes (MDS) are a group of clonal hematopoietic stem cell disorders.
- Accurate prognostic stratification is crucial for guiding treatment decisions in MDS patients.
- Many scoring systems exist, but their utility in elderly patients with comorbidities is debated.
Purpose:
- To evaluate the predictive value of the Bournemouth score for overall survival and acute myeloid leukemia (AML) development in elderly MDS patients.
- To identify the most significant predictor of mortality and leukemic transformation in this cohort.
- To assess the feasibility of using simplified prognostic tools in elderly patients unable to tolerate aggressive therapies.
Summary:
- A study of 54 elderly MDS patients (median age 78.5 years) utilized the Bournemouth score without cytogenetic analysis.
- Severe peripheral cytopenia, RAEB-T, a high proportion of bone marrow blasts (>20%), and higher Bournemouth scores (3-4) correlated with shorter survival and faster AML development.
- Multivariate Cox regression analysis identified a high percentage of bone marrow blasts as the strongest predictor of death and leukemic evolution.
Impact:
- The Bournemouth score is confirmed as a valuable tool for risk stratification in elderly MDS patients.
- High bone marrow blast percentage emerges as a key independent predictor for adverse outcomes, including mortality and AML transformation.
- This study supports the use of simplified prognostic assessments in elderly MDS populations, avoiding complex and costly cytogenetic analyses.