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Myelodysplastic syndrome

Comparison of clinical outcomes and prognostic utility of risk stratification tools in patients with therapy-related vs de novo myelodysplastic syndromes: a report on behalf of the MDS Clinical Research Consortium

Leukemia volume 31, pages 1391–1397 (2017)Cite this article

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Abstract

While therapy-related (t)-myelodysplastic syndromes (MDS) have worse outcomes than de novo MDS (d-MDS), some t-MDS patients have an indolent course. Most MDS prognostic models excluded t-MDS patients during development. The performances of the International Prognostic Scoring System (IPSS), revised IPSS (IPSS-R), MD Anderson Global Prognostic System (MPSS), WHO Prognostic Scoring System (WPSS) and t-MDS Prognostic System (TPSS) were compared among patients with t-MDS. Akaike information criteria (AIC) assessed the relative goodness of fit of the models. We identified 370 t-MDS patients (19%) among 1950 MDS patients. Prior therapy included chemotherapy alone (48%), chemoradiation (31%), and radiation alone in 21%. Median survival for t-MDS patients was significantly shorter than for d-MDS (19 vs 46 months, P<0.005). All models discriminated survival in t-MDS (P<0.005 for each model). Patients with t-MDS had a significantly higher hazard of death relative to d-MDS in every risk model, and had inferior survival compared to patients with d-MDS within all risk group categories. AIC Scores (lower is better) were 2316 (MPSS), 2343 (TPSS), 2343 (IPSS-R), 2361 (WPSS) and 2364 (IPSS). In conclusion, subsets of t-MDS patients with varying clinical outcomes can be identified using conventional risk stratification models. The MPSS, TPSS and IPSS-R provide the best predictive power.

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Acknowledgements

Funding for this research has been provided, in part from the Edward P. Evans Foundation to EP, MAS, DPS, AD, GR, GGM and RK.

Author contributions

AMZ designed the research, interpreted the data and wrote the manuscript. RK designed the research, supervised data analysis, interpreted the data, and critically revised the manuscript. JB analyzed the data and contributed to manuscript writing. NAA, EP, JEL, MAS, DPS, AD, GR, EJ, GGM, and AL reviewed the data and critically reviewed and contributed to the manuscript significantly. All authors approved the final manuscript for submission.

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Authors and Affiliations

  1. Department of Internal Medicine, Section of Hematology, Yale University, and Yale Comprehensive Cancer Center, New Haven, CT, USA

    A M Zeidan

  2. Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    N Al Ali, E Padron, J E Lancet, A List & R Komrokji

  3. Department of Hematology and Medical Oncology, Leukemia Program, Cleveland Clinic, Cleveland, OH, USA

    J Barnard & M A Sekeres

  4. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    D P Steensma

  5. Department of Medicine, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA

    A DeZern

  6. Department of Medicine, Division of Hematology and Oncology, Weill Medical College of Cornell University, New York, NY, USA

    G Roboz

  7. Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA

    E Jabbour & G Garcia-Manero

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  1. A M Zeidan
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Correspondence to A M Zeidan.

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Zeidan, A., Al Ali, N., Barnard, J. et al. Comparison of clinical outcomes and prognostic utility of risk stratification tools in patients with therapy-related vs de novo myelodysplastic syndromes: a report on behalf of the MDS Clinical Research Consortium. Leukemia 31, 1391–1397 (2017). https://doi.org/10.1038/leu.2017.33

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