International scoring system for evaluating prognosis in myelodysplastic syndromes
International scoring system for evaluating prognosis in myelodysplastic syndromes
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DOI：
10.1182/blood.v89.6.2079
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发表时间：
1997-03-15
期刊：
影响因子：
20.3
通讯作者：
Bennett, J
中科院分区：
文献类型：
--
作者：
Greenberg, P;Cox, C;Bennett, J
尽管有多种不同的预后风险分析系统用于评估骨髓增生异常综合征（MDS）患者的临床结局，但此类分析仍存在不精确性。为了改进这些系统，国际MDS风险分析研讨会结合了来自7项先前报道的大型基于风险的研究的细胞遗传学、形态学和临床数据，这些研究已经产生了预后系统。对这些患者进行了全面分析，并重新评估了关键的预后变量，以生成共识预后系统，特别是使用更精确的骨髓（BM）细胞遗传学分类。单变量分析表明，影响急性髓性白血病进展的疾病结局的主要变量是细胞遗传学异常、BM成髓细胞百分比和血细胞减少数;对于生存率，除上述变量外，变量还包括年龄和性别。结果的细胞遗传学亚组如下：“良好"结果为正常、仅-Y、仅del（5 q）、仅del（20 q）;”差"结果为复杂（即，大于或等于3个异常）或7号染色体异常;“中等"结果为其他异常。多变量分析将这些细胞遗传学亚组与BM原始细胞百分比和血细胞减少数相结合，以生成预后模型。根据统计学功效对这些变量进行加权，将患者分为不同的风险亚组，25%的患者发生急性髓性白血病进展，其中：低风险（31%的患者），9.4年;中等风险-1（INT-1; 39%），3.3年; INT-2（22%），1.1年;高风险（8%），0.2年。这些特征也将患者分为中位生存期相似的独特风险组：低，5.7年; INT-1，3.5年; INT-2，1.2年;和高，0.4年。年龄分层进一步改善了生存分析。与以前的基于风险的分类相比，这个国际预后评分系统提供了一种改进的方法来评估MDS的预后。这个分类系统应该证明是有用的，更精确的设计和分析，在这种疾病的治疗试验。(C)1997年，美国血液学会。
Despite multiple disparate prognostic risk analysis systems for evaluating clinical outcome for patients with myelodysplastic syndrome (MDS), imprecision persists with such analyses. To attempt to improve on these systems, an International MDS Risk Analysis Workshop combined cytogenetic, morphological, and clinical data from seven large previously reported risk-based studies that had generated prognostic systems. A global analysis was performed on these patients, and critical prognostic variables were re-evaluated to generate a consensus prognostic system, particularly using a more refined bone marrow (BM) cytogenetic classification. Univariate analysis indicated that the major variables having an impact on disease outcome for evolution to acute myeloid leukemia were cytogenetic abnormalities, percentage of BM myeloblasts, and number of cytopenias; for survival, in addition to the above, variables also included age and gender. Cytogenetic subgroups of outcome were as follows: ''good'' outcomes were normal, -Y alone, del(5q) alone, del(20q) alone; ''poor'' outcomes were complex (ie, greater than or equal to 3 abnormalities) or chromosome 7 anomalies; and ''intermediate'' outcomes were other abnormalities. Multivariate analysis combined these cytogenetic subgroups with percentage of BM blasts and number of cytopenias to generate a prognostic model. Weighting these variables by their statistical power separated patients into distinctive subgroups of risk for 25% of patients to undergo evolution to acute myeloid leukemia, with: low (31% of patients), 9.4 years; intermediate-1 (INT-1; 39%), 3.3 years; INT-2 (22%), 1.1 years; and high (8%), 0.2 year. These features also separated patients into similar distinctive risk groups for median survival: low, 5.7 years; INT-1, 3.5 years; INT-2, 1.2 years; and high, 0.4 year. Stratification for age further improved analysis of survival. Compared with prior risk-based classifications, this International Prognostic Scoring System provides an improved method for evaluating prognosis in MDS. This classification system should prove useful for more precise design and analysis of therapeutic trials in this disease. (C) 1997 by The American Society of Hematology.