Myelodysplastic syndromes: analysis of clinical and prognostic features in 96 patients

In a retrospective study of 96 patients with a myelodysplastic syndrome the FAB classification, Bournemouth score and other parameters were correlated with leukaemic transformation and survival. Diagnosis was refractory anaemia (RA) in 7 patients, acquired idiopathic sideroblastic anaemia (AISA) in 2, chronic myelomonocytic leukaemia (CMML) in 31, refractory anaemia with excess of blasts (RAEB) in 34 and RAEB in transformation (RAEB-t) in 22. Median survival for all patients was 37 weeks (RA and AISA 103, CMML 67, RAEB 35, RAEB-t 27). Scoring according to the Bournemouth criteria showed significant differences in survival between groups A, B and C. Of the separate variables, only percentage of bone marrow blasts and haemoglobin level were prognostically significant. A modified scoring system based upon these two variables was even more discriminative. It proved to be particularly useful in CMML, a subtype with a wide range of survival times. Leukaemic transformation was seen in 39% (RA and AISA 0%, CMML 30%, RAEB 39%, RAEB-t 75%).