TY - JOUR
T1 - Time-dependent changes in mortality and transformation risk in MDS
AU - Pfeilstöcker, Michael
AU - Tuechler, Heinz
AU - Sanz, Guillermo
AU - Schanz, Julie
AU - Garcia-Manero, Guillermo
AU - Solé, Francesc
AU - Bennett, John M.
AU - Bowen, David
AU - Fenaux, Pierre
AU - Dreyfus, Francois
AU - Kantarjian, Hagop
AU - Kuendgen, Andrea
AU - Malcovati, Luca
AU - Cazzola, Mario
AU - Cermak, Jaroslav
AU - Fonatsch, Christa
AU - Le Beau, Michelle M.
AU - Slovak, Marilyn L.
AU - Levis, Alessandro
AU - Luebbert, Michael
AU - Maciejewski, Jaroslaw
AU - Machherndl-Spandl, Sigrid
AU - Magalhaes, Silvia M.M.
AU - Miyazaki, Yasushi
AU - Sekeres, Mikkael A.
AU - Sperr, Wolfgang R.
AU - Stauder, Reinhard
AU - Tauro, Sudhir
AU - Valent, Peter
AU - Vallespi, Teresa
AU - Van De Loosdrecht, Arjan A.
AU - Germing, Ulrich
AU - Haase, Detlef
AU - Greenberg, Peter L.
N1 - Publisher Copyright:
© 2016 by The American Society of Hematology.
PY - 2016/8/18
Y1 - 2016/8/18
N2 - In myelodysplastic syndromes (MDSs), the evolution of risk for disease progression or death has not been systematically investigated despite being crucial for correct interpretation of prognostic risk scores. In a multicenter retrospective study, we described changes in risk over time, the consequences for basal prognostic scores, and their potential clinical implications. Major MDS prognostic risk scoring systems and their constituent individual predictors were analyzed in 7212 primary untreated MDS patients from the International Working Group for Prognosis in MDS database. Changes in risk of mortality and of leukemic transformation over time from diagnosis were described. Hazards regarding mortality and acute myeloid leukemia transformation diminished over time from diagnosis in higher-risk MDS patients, whereas they remained stable in lower-risk patients. After approximately 3.5 years, hazards in the separate risk groups became similar and were essentially equivalent after 5 years. This fact led to loss of prognostic power of different scoring systems considered, which was more pronounced for survival. Inclusion of age resulted in increased initial prognostic power for survival and less attenuation in hazards. If needed for practicability in clinical management, the differing development of risks suggested a reasonable division into lower- and higher-risk MDS based on the IPSS-R at a cutoff of 3.5 points. Our data regarding time-dependent performance of prognostic scores reflect the disparate change of risks in MDS subpopulations. Lower-risk patients at diagnosis remain lower risk whereas initially high-risk patients demonstrate decreasing risk over time. This change of risk should be considered in clinical decision making.
AB - In myelodysplastic syndromes (MDSs), the evolution of risk for disease progression or death has not been systematically investigated despite being crucial for correct interpretation of prognostic risk scores. In a multicenter retrospective study, we described changes in risk over time, the consequences for basal prognostic scores, and their potential clinical implications. Major MDS prognostic risk scoring systems and their constituent individual predictors were analyzed in 7212 primary untreated MDS patients from the International Working Group for Prognosis in MDS database. Changes in risk of mortality and of leukemic transformation over time from diagnosis were described. Hazards regarding mortality and acute myeloid leukemia transformation diminished over time from diagnosis in higher-risk MDS patients, whereas they remained stable in lower-risk patients. After approximately 3.5 years, hazards in the separate risk groups became similar and were essentially equivalent after 5 years. This fact led to loss of prognostic power of different scoring systems considered, which was more pronounced for survival. Inclusion of age resulted in increased initial prognostic power for survival and less attenuation in hazards. If needed for practicability in clinical management, the differing development of risks suggested a reasonable division into lower- and higher-risk MDS based on the IPSS-R at a cutoff of 3.5 points. Our data regarding time-dependent performance of prognostic scores reflect the disparate change of risks in MDS subpopulations. Lower-risk patients at diagnosis remain lower risk whereas initially high-risk patients demonstrate decreasing risk over time. This change of risk should be considered in clinical decision making.
UR - http://www.scopus.com/inward/record.url?scp=84983344821&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84983344821&partnerID=8YFLogxK
U2 - 10.1182/blood-2016-02-700054
DO - 10.1182/blood-2016-02-700054
M3 - Article
C2 - 27335276
AN - SCOPUS:84983344821
SN - 0006-4971
VL - 128
SP - 902
EP - 910
JO - Blood
JF - Blood
IS - 7
ER -