Proposal for a new risk model in myelodysplastic syndrome that accounts for events not considered in the original International Prognostic Scoring System.
Proposal for a new risk model in myelodysplastic syndrome that accounts for events not considered in the original International Prognostic Scoring System.
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DOI：
10.1002/cncr.23697
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发表时间：
2008-09-15
期刊：
影响因子：
6.2
通讯作者：
Garcia-Manero G
中科院分区：
文献类型：
--
作者：
Kantarjian H;O'Brien S;Ravandi F;Cortes J;Shan J;Bennett JM;List A;Fenaux P;Sanz G;Issa JP;Freireich EJ;Garcia-Manero G
近期研究强调了国际预后评分系统（IPSS）模型存在的问题，该模型排除了许多现在在骨髓增生异常综合征（MDS）患者中占很大比例的亚组（例如，继发性MDS、伴有白细胞增多的慢性粒单核细胞白血病[CMML]、既往接受过治疗），并且它对大多数参与研究项目的患者不适用，因为很多患者可能已经接受过既往治疗，并且患MDS已有相当长的时间。
作者分析了1993年至2005年转诊的1915例MDS患者（包括患有CMML、继发性MDS以及既往接受过治疗的MDS患者）。只有507例患者（26%）为未接受过既往治疗的原发性MDS（即可以用IPSS分类）。患者被随机分为研究组（n = 958）和测试组（n = 957）。
对研究组预后因素的多变量分析确定了以下不良的独立因素作为连续值和分类值（P<0.001）：体能状态差、年龄较大、血小板减少、贫血、骨髓原始细胞增多、白细胞增多、7号染色体或复杂（≥3种）异常以及既往输血。根据IPSS，贫血、血小板减少和原始细胞以及细胞遗传学亚组的临界值是不同的。新的MDS预后模型将患者分为4个预后组，其结果有显著差异。该模型在测试组中得到了验证。在4个IPSS风险组内、总体以及在未接受过既往治疗的原发性MDS患者中应用新模型的预后评分，发现在每个亚组中都具有高度的预后价值。在新的MDS模型的4个风险组中的每一组内应用IPSS未发现有预后价值。
新模型考虑了MDS的病程和既往治疗情况。它适用于MDS病程中任何时间的任何MDS患者。
Recent studies have highlighted issues with the International Prognostic Scoring System (IPSS) model in relation to the exclusion of many subgroups that now represent a large proportion of patients with myelodysplastic syndrome (MDS) (eg, secondary MDS, chronic myelomonocytic leukemia [CMML] with leukocytosis, prior therapy) and its lack of applicability to most patients on investigational programs, because many would have received prior therapies and would have had MDS for a significant length of time. The authors analyzed 1915 patients with MDS who were referred from 1993 to 2005 (including those with CMML, secondary MDS, and MDS with prior therapy). Only 507 patients (26%) had primary MDS without prior therapy (ie, classifiable by the IPSS). Patients were divided randomly into a study group (n = 958) and a test group (n = 957). A multivariate analysis of prognostic factors in the study group identified the following adverse, independent factors as continuous and categoric values (P<.001): poor performance, older age, thrombocytopenia, anemia, increased bone marrow blasts, leukocytosis, chromosome 7 or complex (≥3) abnormalities, and prior transfusions. Cutoffs for anemia, thrombocytopenia and blasts, and cytogenetic subsets were different according to the IPSS. The new MDS prognostic model divided patients into 4 prognostic groups with significantly different outcomes. The model was validated in the test group. Applying the prognostic score of the new model within the 4 IPSS risk groups, overall, and in patients who had primary MDS without prior therapy was found to be highly prognostic in each subset. Applying the IPSS within each of the 4 risk groups of the new MDS model was not found to be prognostic. The new model accounts for duration of MDS and prior therapy. It is applicable to any patient with MDS at any time during the course of MDS.
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