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Prognostic factors of myelodysplastic syndromes--a simplified 3-D scoring system
J E Goasguen1, R Garand, M Bizet
1French University, Rennes.
Insights
Myelodysplastic syndromes (MDS) survival is best predicted by hemoglobin, platelets, and bone marrow blasts. These factors, especially blasts and platelets, significantly correlate with patient outcomes and leukemic transformation risk.
Area of Science:
- Hematology
- Oncology
- Clinical Research
Background:
- Myelodysplastic syndromes (MDS) are a group of clonal hematopoietic stem cell disorders.
- Accurate prognostication is crucial for managing MDS patients and guiding treatment decisions.
Purpose of the Study:
- To identify key factors predicting survival and leukemic transformation in a large cohort of MDS patients.
- To evaluate the utility of a novel 3-dimensional scoring system for MDS prognostication.
Main Methods:
- Retrospective analysis of 503 MDS cases diagnosed between 1982-1986 across five French hematological centers.
- Classification of MDS subtypes according to FAB criteria.
- Application of the Bournemouth scoring method and development of a 3-D scoring system based on hemoglobin, platelets, and bone marrow blasts.
Main Results:
- Hemoglobin, platelets, and bone marrow blasts were identified as the strongest predictors of survival and leukemic transformation (LT).
- A 3-D scoring system incorporating these parameters demonstrated significant correlation with survival, mortality, and LT (p < 0.0001).
- Refractory anemia with excess blasts (RAEB), RAEB-t, and chronic myelomonocytic leukemia (CMML) showed progression to acute myeloid leukemia (AML).
Conclusions:
- A scoring system based on hemoglobin, platelets, and bone marrow blasts is a valuable tool for predicting MDS patient outcomes.
- Bone marrow blasts and platelet counts are the most critical factors influencing survival and leukemic transformation in MDS.
- Monocyte counts were not found to be reliable predictors of leukemic transformation type.
Abstract:
From 1 January 1982 to 31 December 1986 in five haematological centers of the west of France (Rennes, Rouen, Nantes, Tours and Angers), we have collected 503 cases of myelodysplastic syndrome (MDS). These cases were classified by FAB recommendation as followed: 85 refractory anemia with ring sideroblasts (RARS); 273 refractory anemia in which 86 were without blasts (RA), 153 were with excess of blasts (RAEB) and 34 were with excess of blasts and in transformation (RAEB-t); 111 chronic myelomonocytic leukaemia (CMML); and 34 cases with borderline features. The point date for statistical study was 31 December 1988, and the scoring method of Bournemouth was applied to compare with our findings (62% resulted in death, 18% in leukemic transformation). It was demonstrated that haemoglobin, platelets, and bone marrow-blasts are the best factors to predict survival or leukaemic transformation (LT). But peripheral neutrophils don't affect the survival time excepted when lower than 500 microliters (13 months vs 19.6 months). A scoring system based on haemoglobin (Hb), platelets (Pl), and bone marrow blasts (BMB) may be represented in a three-dimensional space and is a good tool to know the own value of each parameter. This 3-D system shows that BMB and Pl are the most important factors and are correlated with survival, per cent of death, and LT (p less than 0.0001). The LT is observed in 18% of the whole population. RAEB and RAEB-t progress in AML2 (14.6%) or AML4 (1.4%), and CMML progress in AML2 (8.1%) or AML4 (11.7%). We observed that monocytes are not good parameters to predict the type of leukemic transformation. Furthermore, survival of RA treated with Ara-C(ld) or not treated was similar.