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Comparative Study
. 2016 Mar;30(3):649-57.
doi: 10.1038/leu.2015.283. Epub 2015 Oct 14.

Comparison of risk stratification tools in predicting outcomes of patients with higher-risk myelodysplastic syndromes treated with azanucleosides

A M Zeidan  1 , M A Sekeres  2 , G Garcia-Manero  3 , D P Steensma  4 , K Zell  2 , J Barnard  2 , N A Ali  5 , C Zimmerman  2 , G Roboz  6 , A DeZern  7 , A Nazha  2 , E Jabbour  3 , H Kantarjian  3 , S D Gore  1 , J P Maciejewski  2 , A List  5 , R Komrokji  5 ; MDS Clinical Research Consortium
Affiliations
Comparative Study

Comparison of risk stratification tools in predicting outcomes of patients with higher-risk myelodysplastic syndromes treated with azanucleosides

A M Zeidan et al. Leukemia. 2016 Mar.

Abstract

Established prognostic tools in patients with myelodysplastic syndromes (MDS) were largely derived from untreated patient cohorts. Although azanucleosides are standard therapies for higher-risk (HR)-MDS, the relative prognostic performance of existing prognostic tools among patients with HR-MDS receiving azanucleoside therapy is unknown. In the MDS Clinical Research Consortium database, we compared the prognostic utility of the International Prognostic Scoring System (IPSS), revised IPSS (IPSS-R), MD Anderson Prognostic Scoring System (MDAPSS), World Health Organization-based Prognostic Scoring System (WPSS) and the French Prognostic Scoring System (FPSS) among 632 patients who presented with HR-MDS and were treated with azanucleosides as the first-line therapy. Median follow-up from diagnosis was 15.7 months. No prognostic tool predicted the probability of achieving an objective response. Nonetheless, all five tools were associated with overall survival (OS, P=0.025 for the IPSS, P=0.011 for WPSS and P<0.001 for the other three tools). The corrected Akaike Information Criteria, which were used to compare OS with the different prognostic scoring systems as covariates (lower is better) were 4138 (MDAPSS), 4156 (FPSS), 4196 (IPSS-R), 4186 (WPSS) and 4196 (IPSS). Patients in the highest-risk groups of the prognostic tools had a median OS from diagnosis of 11-16 months and should be considered for up-front transplantation or experimental approaches.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Unadjusted Kaplan – Meier estimates for overall survival from the time of diagnosis for the entire cohort (a) and as stratified by the type of azanucleoside received (b).
Figure 2
Figure 2
Kaplan–Meier estimates for overall survival from time of diagnosis as stratified by the risk groups within each of the five prognostic tools: (a) IPSS, (b) IPSS-R, (c) MDAPSS, (d) FPSS and (e) WPSS.
Figure 3
Figure 3
Kaplan – Meier estimates for leukemia-free survival from time of diagnosis as stratified by the risk groups within each of the 5 prognostic tools: (a) IPSS, (b) IPSS-R, (c) MDAPSS, (d) FPSS and (e) WPSS.
See this image and copyright information in PMC

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