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. 2011 Oct;96(10):1433-40.
doi: 10.3324/haematol.2011.044602. Epub 2011 Jun 9.

Impact of the degree of anemia on the outcome of patients with myelodysplastic syndrome and its integration into the WHO classification-based Prognostic Scoring System (WPSS)

Luca Malcovati  1 , Matteo G Della Porta, Corinna Strupp, Ilaria Ambaglio, Andrea Kuendgen, Kathrin Nachtkamp, Erica Travaglino, Rosangela Invernizzi, Cristiana Pascutto, Mario Lazzarino, Ulrich Germing, Mario Cazzola
Affiliations

Impact of the degree of anemia on the outcome of patients with myelodysplastic syndrome and its integration into the WHO classification-based Prognostic Scoring System (WPSS)

Luca Malcovati et al. Haematologica. 2011 Oct.

Abstract

Background: Anemia is an established negative prognostic factor in myelodysplastic syndromes but the relationship between its degree and clinical outcome is poorly defined. We, therefore, studied the relationship between severity of anemia and outcome in myelodysplastic syndrome patients.

Design and methods: We studied 840 consecutive patients diagnosed with myelodysplastic syndromes at the Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, and 504 patients seen at the Heinrich-Heine-University Hospital, Düsseldorf, Germany. Hemoglobin levels were monitored longitudinally and analyzed by means of time-dependent Cox's proportional hazards regression models.

Results: Hemoglobin levels lower than 9 g/dL in males (HR 5.56, P=0.018) and 8 g/dL in females (HR=5.35, P=0.026) were independently related to reduced overall survival, higher risk of non-leukemic death and cardiac death (P<0.001). Severe anemia, defined as hemoglobin below these thresholds, was found to be as effective as transfusion-dependency in the prognostic assessment. After integrating this definition of severe anemia into the WHO classification-based Prognostic Scoring System, time-dependent regression and landmark analyses showed that the refined model was able to identify risk groups with different survivals at any time during follow up.

Conclusions: Accounting for severity of anemia through the WHO classification-based Prognostic Scoring System provides an objective criterion for prognostic assessment and implementation of risk-adapted treatment strategies in myelodysplastic syndrome patients.

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Figures

Figure 1.
Figure 1.
Prognostic relevance of the degree of anemia in patients with MDS. These curves were estimated from Cox’s regression analyses with time-dependent covariates in the learning cohort of MDS patients. (A) Probability of non-leukemic death according to the degree of anemia in males (hemoglobin categories that showed no significantly different probabilities of NLD were plotted together). (B) Probability of non-leukemic death according to the degree of anemia in females (hemoglobin categories that showed no significantly different probabilities of NLD were plotted together).
Figure 2.
Figure 2.
Relationship between severe anemia and cardiac disease. Data were generated in the learning cohort of MDS patients. (A) Probability of developing cardiac disease and death according to the degree of anemia. (B) Probability of developing cardiac disease and death according to the presence or absence of transfusion dependency as defined in this work (i.e. absence of a period free from transfusion longer than 28 days over a surveillance period of eight weeks).
Figure 3.
Figure 3.
Probability of overall survival according to the refined WPSS risk. Data were generated in the learning cohort of MDS patients. (A) Probability of overall survival of the refined WPSS risk groups at the time of diagnosis. (B-G) Landmark analyses at (B) six, (C) 12, (D) 24, (E) 36, (F) 48 and (G) 60 months from diagnosis.
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References

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