Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Jul;88(7):566-70.
doi: 10.1002/ajh.23454. Epub 2013 May 30.

Validation of the revised International Prognostic Scoring System in treated patients with myelodysplastic syndromes

Asmita Mishra  1 , Maria Corrales-Yepez, Najla Al Ali, Mohamed Kharfan-Dabaja, Eric Padron, Ling Zhang, Pearlie K Epling-Burnette, Javier Pinilla-Ibarz, Jeffrey E Lancet, Alan F List, Rami S Komrokji
Affiliations

Validation of the revised International Prognostic Scoring System in treated patients with myelodysplastic syndromes

Asmita Mishra et al. Am J Hematol. 2013 Jul.

Abstract

The International Prognostic Scoring System (IPSS) was recently revised (IPSS-R) under the auspices of the MDS Foundation as a collaborative international effort to refine its prognostic power. Our purpose was to externally validate this new risk model using a large single-institution cohort, determine its prognostic power in patients receiving active treatment, and explore its utility in guiding therapeutic decisions. Data were collected retrospectively from our myelodysplastic syndrome (MDS) database and verified by chart review. Of the data available for 1,088 patients, 152 (14%), 353 (32%), 237 (22%), 190 (18%), and 156 (14%) patients were classified as very low, low, intermediate, high, and very high risk, respectively, with median overall survival (OS) of 90 (95%CI 71-109), 54 (95%CI 50-59), 34 (95%CI 26-43), 21 (95%CI 17-25), and 13 months (95%CI 11-15), respectively (P < 0.005). We found that the IPSS-R further refined prognostic discrimination in all IPSS risk categories, particularly in the intermediate 1 and 2 groups. Among high and very high IPSS-R patients receiving azacitidine, OS was significantly improved versus patients not receiving azacitidine, with corresponding median OS of 25 versus 18 months (P = 0.028) and 15 versus 9 months (P = 0.005), respectively. Similarly, patients with IPSS-R high- and very high-risk disease who underwent allogeneic hematopoietic stem cell transplantation had significantly improved OS versus nontransplant approaches (P < 0.005). High and very high IPSS-R patients derived a survival advantage from disease-modifying therapies. Our data validate the prognostic value of the proposed IPSS-R and show that its refined IPSS prognostic discrimination can be applied to actively treated patients.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: Nothing to report.

Figures

Figure 1
Figure 1
Median OS in patients with MDS based on International Prognostic Scoring System (A) and MD Anderson Scoring System (B). [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
Figure 2
Figure 2
Median OS for patients with MDS based on revised IPSS (IPSS-R). [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
See this image and copyright information in PMC

References

    1. Bennett JM, Komrokji R, Kouides P. The myelodysplastic syndromes. In: Abel-off MD, Armitage JO, Niederhuber JE, editors. Clinical Oncology. New York: Churchill Livingstone; 2004. pp. 2849–2881.
    1. Komrokji RS, Zhang L, Bennett JM. Myelodysplastic syndromes classification and risk stratification. Hematol Oncol Clin North Am. 2010;24:443–457. - PubMed
    1. Greenberg P, Cox C, LeBeau MM, et al. International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood. 1997;89:2079–2088. - PubMed
    1. NCCN Clinical Practice Guidelines in Oncology. Myelodysplastic Syndromes (Version 2, 2013) [Accessed December 16, 2012]; // www.nccn.org/professionals/physician_gls/f_guidelines.asp#mds.
    1. Greenberg P, Tuechler H, Schanz J, et al. Revised international prognostic scoring system for myelodysplastic syndromes. Blood. 2012;120:2454–2465. - PMC - PubMed

Publication types

Substances