Detection of risk groups in myelodysplastic syndromes. A multicenter study
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Published on: October 3, 2018
Carolina Belli1, Susana Acevedo, Raquel Bengio
1Instituto de Investigaciones Hematológicas Martino R. Castex, Academia Nacional de Medicina, Pacheco de Melo 3081, CP 1425, Capital Federal, Argentina. lacuteci@intramed.net.ar
Background And Objectives:
Myelodysplastic syndromes (MDS) comprise a group of heterogeneous hematologic disorders with risk of leukemic evolution (LE). The French-American-British (FAB) co-operative group classifies them into five morphologic entities and the International Prognostic Scoring System (IPSS) proposes four groups of risk on the basis of clinical and cytogenetic variables. The aim of this study was to evaluate the application of the IPSS in our Argentine population, to test the prognostic value of its variables and to determine whether this score helps to associate prognostic subgroups of risk into FAB subtypes.
Design And Methods:
Two hundred and thirty-four patients with primary MDS and a median follow-up of 28 months were evaluated using univariate analyses to determine median survival (SV) and the time to LE. The variables analyzed were FAB classification, IPSS, percentage of myeloblasts, cytogenetic groups of risk and number of cytopenias.
Results:
Univariate analyses showed that all variables analyzed were predictive for SV and for LE in our MDS population. Application of the IPSS allowed discrimination into the 4 groups of risk and helped to identify prognostic subclasses among the FAB classification, associating 5%, 15% and 19% of cases with worse prognosis within the FAB classification of refractory anemia (RA), RA with ringed sideroblasts and RA with excess of blasts (RAEB), respectively. The IPSS was not informative for RAEB in transformation cases and would not be applied to patients with chronic myelomonocytic leukemia.
Interpretation And Conclusions:
This score could be applied to our MDS population, showing no geographic differences. Stratification of FAB patients according to IPSS would be helpful to develop risk-adapted therapeutic strategies.
Insights
The International Prognostic Scoring System (IPSS) effectively predicts survival and leukemic evolution in Argentine myelodysplastic syndromes (MDS) patients, regardless of geographic location. This score aids in stratifying risk within French-American-British (FAB) subtypes for tailored therapies.
Area of Science:
- Hematology
- Oncology
- Clinical Prognostics
Background:
- Myelodysplastic syndromes (MDS) are heterogeneous hematologic disorders with a risk of leukemic evolution.
- The French-American-British (FAB) classification and International Prognostic Scoring System (IPSS) are established systems for MDS prognostication.
- Geographic variations in IPSS applicability for MDS require investigation.
Purpose of the Study:
- To evaluate the applicability of the IPSS in an Argentine MDS population.
- To assess the prognostic value of IPSS variables for survival and leukemic evolution.
- To determine if IPSS helps stratify risk within FAB subtypes.
Main Methods:
- A cohort of 234 primary MDS patients with a median follow-up of 28 months was analyzed.
- Univariate analyses were performed on FAB classification, IPSS, myeloblast percentage, cytogenetic risk, and cytopenias.
- Median survival and time to leukemic evolution were key outcome measures.
Main Results:
- All analyzed variables, including IPSS, were predictive of survival and leukemic evolution in the Argentine MDS cohort.
- The IPSS successfully discriminated patients into four risk groups.
- IPSS identified prognostic subclasses within FAB subtypes, notably associating higher risk with specific refractory anemia categories.
Conclusions:
- The IPSS is applicable to the Argentine MDS population without significant geographic differences.
- Stratifying FAB-classified MDS patients using IPSS can inform the development of risk-adapted therapeutic strategies.
- IPSS provides valuable prognostic information for managing MDS patients.
