Clinical Prognostic Factors for Survival and Risk of Progression to Acute Myeloid Leukemia in Patients With Myelodysplastic Syndromes With < 10% Marrow Blasts and Non-Unfavorable Cytogenetic Categories
Clinical Prognostic Factors for Survival and Risk of Progression to Acute Myeloid Leukemia in Patients With Myelodysplastic Syndromes With < 10% Marrow Blasts and Non-Unfavorable Cytogenetic Categories
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DOI：
10.1016/j.clml.2012.09.013
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发表时间：
2013-04-01
影响因子：
2.7
通讯作者：
Perez-Simon, Jose A.
中科院分区：
文献类型：
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作者：
Falantes, Jose F.;Calderon, Cristina;Perez-Simon, Jose A.
骨髓增生异常综合征(MDS)的预后是一个持续关注的领域。确定低风险疾病类别中预后较差的患者至关重要。在这项研究中，我们将332名低风险MDS患者分为3组，在存活率和白血病进展风险方面存在差异，这可能会推动治疗方法来改善其中一小部分患者的预后。背景：MDS的预后，特别是在被归类为低风险患者(<；10%原始细胞或低和中1国际预后评分系统[IPSS])的患者中，具有非常不同的异质性，包括使用当前评分系统的患者具有非常不同的结果。最近，一种新的细胞遗传学分类被提出用于修订的IPSS以预测MDS的结果。患者和方法：为了评估多个变量对生存和进展为急性髓系白血病的风险的预后意义，我们分析了332例低风险细胞遗传学分类的低风险MDS患者的基线特征，以及最近提出的新的细胞遗传学分类。结果：在多因素分析中，细胞减少的严重程度、年龄和60岁、骨髓母细胞(5%-9%)和输血依赖性对预后有显著影响。这些变量的组合允许建立一个模型，该模型将患者分成3组，第1组、第2组和第3组的中位生存期分别为95、44和13个月(P<；.001)。此外，这一评分还对患者的白血病进展风险进行了分层，估计两年内每组分别为3.1%、7.6%和21.3%(P=.024)。结论：尽管核型仍然是MDS的主要预后因素，但目前的研究确定了在细胞遗传学特征较好的患者中预测预后的临床参数。细胞减少的程度、原始细胞5%-9%和输血依赖可以确定非不利核型中的一组患者，在这些患者中，可能需要早期或更具侵袭性的方法来提高存活率或防止疾病进展。(C)2013 Elsevier Inc.保留所有权利。(C)2013 Elsevier Inc.保留所有权利。
Prognosis of myelodysplastic syndromes (MDS) is an area of ongoing interest. Identification of patients with poor outcome in the categories of lower risk disease is critical. In this study, we classify a cohort of 332 lower risk MDS into 3 groups with differences in survival and risk for leukemic progression that could drive treatment approaches to improve prognosis in a fraction of these patients.Background: Prognosis of MDS and particularly in patients categorized as lower risk (< 10% blasts or low and intermediate-1 International Prognostic Scoring System [IPSS]) is very heterogeneous and includes patients with very different outcomes with current scoring systems. Recently, a new cytogenetic classification has been proposed for the revised IPSS in predicting the outcome for MDS. Patients and Methods: To evaluate the prognostic significance of multiple variables for survival and risk of progression to acute myeloid leukemia, we analyzed baseline characteristics of 332 lower risk MDS patients within the lower risk cytogenetic categories by IPSS and the recent proposal for the new cytogenetic classification. Results: In multivariate analysis, severity of cytopenias, age > 60 years, bone marrow blasts (5%-9%) and transfusion dependency significantly influenced outcome. The combination of these variables allowed development of a model which categorizes patients in 3 different groups with median survival of 95, 44, and 13 months for groups 1, 2, and 3, respectively (P < .001). In addition, this score also stratified patients for their risk for leukemic progression, estimated at 2 years in 3.1%, 7.6%, and 21.3% for each group (P = .024). Conclusion: Although karyotype remains the main prognostic factor in MDS, the current study identifies clinical parameters predicting outcome among patients with the better cytogenetic profile. Degree of cytopenias, blasts 5%-9% and transfusion dependence might identify a subset of patients within the nonadverse karyotype, in which early or more aggressive approaches could possibly be required to improve survival or prevent disease progression. (C) 2013 Elsevier Inc. All rights reserved. (C) 2013 Elsevier Inc. All rights reserved.