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Multicenter Study
. 2011 May 20;29(15):1963-70.
doi: 10.1200/JCO.2010.28.3978. Epub 2011 Apr 25.

Coalesced multicentric analysis of 2,351 patients with myelodysplastic syndromes indicates an underestimation of poor-risk cytogenetics of myelodysplastic syndromes in the international prognostic scoring system

Julie Schanz  1 , Christian Steidl, Christa Fonatsch, Michael Pfeilstöcker, Thomas Nösslinger, Heinz Tuechler, Peter Valent, Barbara Hildebrandt, Aristoteles Giagounidis, Carlo Aul, Michael Lübbert, Reinhard Stauder, Otto Krieger, Guillermo Garcia-Manero, Hagop Kantarjian, Ulrich Germing, Detlef Haase, Elihu Estey
Affiliations
Multicenter Study

Coalesced multicentric analysis of 2,351 patients with myelodysplastic syndromes indicates an underestimation of poor-risk cytogenetics of myelodysplastic syndromes in the international prognostic scoring system

Julie Schanz et al. J Clin Oncol. .

Abstract

Purpose: The International Prognostic Scoring System (IPSS) remains the most commonly used system for risk classification in myelodysplastic syndromes (MDSs). The IPSS gives more weight to blast count than to cytogenetics. However, previous publications suggested that cytogenetics are underweighted in the IPSS. Here we investigate the prognostic impact of cytogenetic subgroups compared with that of bone marrow blast count in a large, multicentric, international patient cohort.

Patients and methods: In total, 2,351 patients with MDS who have records in the German-Austrian and the MD Anderson Cancer Center databases were included and analyzed in univariate and multivariate models regarding overall survival and risk of transformation to acute myeloid leukemia (AML). The data were analyzed separately for patients treated with supportive care without specific therapy, with AML-like chemotherapy, or with other therapy regimens (low-dose chemotherapy, demethylating agents, immune modulating agents, valproic acid, and cyclosporine).

Results: The prognostic impact of poor-risk cytogenetic findings (as defined by the IPSS classification) on overall survival was as unfavorable as an increased (> 20%) blast count. The hazard ratio (compared with an abnormal karyotype or a bone marrow blast count < 5%) was 3.3 for poor-risk cytogenetics, 4.8 for complex abnormalities harboring chromosomes 5 and/or 7, and 3.1 for a blast count of 21% to 30% (P < .01 for all categories). The predictive power of the IPSS cytogenetic subgroups was unaffected by type of therapy given.

Conclusion: The independent prognostic impact of poor-risk cytogenetics on overall survival is equivalent to the impact of high blast counts. This finding should be considered in the upcoming revision of the IPSS.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
(A-D) Cumulative survival and cumulative risk of acute myeloid leukemia (AML) transformation in International Prognostic Scoring System (IPSS) cytogenetic and French-American-British classification criteria bone marrow blast count subgroups (univariate analysis; patients treated with supportive care exclusively).
Fig 2.
Fig 2.
Discriminatory power of International Prognostic Scoring System (IPSS) cytogenetic subgroups in distinct therapy categories. (A) Best supportive care; (B) chemotherapy; (C) other therapy.
Fig A1.
Fig A1.
Outcome in patients diagnosed before and after October, 13, 1998 (median date of database entry).
See this image and copyright information in PMC

Comment in

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