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Myelodysplastic syndrome

Comparison of risk stratification tools in predicting outcomes of patients with higher-risk myelodysplastic syndromes treated with azanucleosides

Leukemia volume 30, pages 649–657 (2016)Cite this article

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Abstract

Established prognostic tools in patients with myelodysplastic syndromes (MDS) were largely derived from untreated patient cohorts. Although azanucleosides are standard therapies for higher-risk (HR)-MDS, the relative prognostic performance of existing prognostic tools among patients with HR-MDS receiving azanucleoside therapy is unknown. In the MDS Clinical Research Consortium database, we compared the prognostic utility of the International Prognostic Scoring System (IPSS), revised IPSS (IPSS-R), MD Anderson Prognostic Scoring System (MDAPSS), World Health Organization-based Prognostic Scoring System (WPSS) and the French Prognostic Scoring System (FPSS) among 632 patients who presented with HR-MDS and were treated with azanucleosides as the first-line therapy. Median follow-up from diagnosis was 15.7 months. No prognostic tool predicted the probability of achieving an objective response. Nonetheless, all five tools were associated with overall survival (OS, P=0.025 for the IPSS, P=0.011 for WPSS and P<0.001 for the other three tools). The corrected Akaike Information Criteria, which were used to compare OS with the different prognostic scoring systems as covariates (lower is better) were 4138 (MDAPSS), 4156 (FPSS), 4196 (IPSS-R), 4186 (WPSS) and 4196 (IPSS). Patients in the highest-risk groups of the prognostic tools had a median OS from diagnosis of 11−16 months and should be considered for up-front transplantation or experimental approaches.

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Acknowledgements

We would like to thank the patients who contributed to this large database and their families, as well the research coordinators in the six sites who worked to construct the database. The authors would also like to thank the Evans Foundation and the Aplastic Anemia and Myelodysplastic Syndromes Foundation for supporting the research activities of the MDS Clinical Research Consortium. This research was presented in part at the American Society of Hematology 56th Annual meeting in San Francisco, CA, USA in December 2014. AMZ received funding through MDS Clinical Research Consortium and the American Society of Oncology Young Investigator Award.

Author contributions

AMZ conceived the study concept, analyzed the data and wrote the manuscript. MAS, GG-M, DPS and RK contributed data to the study, analyzed the data and revised the manuscript. KZ and JB analyzed the data, performed the statistical analyses and contributed to manuscript writing. NAA and CZ collected data and reviewed the manuscript. GR, AZ, AN, EJ, HK, SDG, JPM and AL contributed data to the study and reviewed the manuscript. All the authors reviewed the manuscript and approved the final version.

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Authors and Affiliations

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

    A M Zeidan & S D Gore

  2. Department of Translational Hematology and Oncology Research, Leukemia Program, Cleveland Clinic, Cleveland, OH, USA

    M A Sekeres, K Zell, J Barnard, C Zimmerman, A Nazha & J P Maciejewski

  3. Department of leukemia, MD Anderson Cancer Center, Houston, TX, USA

    G Garcia-Manero, E Jabbour & H Kantarjian

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

    D P Steensma

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

    N A Ali, A List & R Komrokji

  6. Department of Medicine, Weill Medical College of Cornell University, New York, NY, USA

    G Roboz

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

    A DeZern

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Zeidan, A., Sekeres, M., Garcia-Manero, G. et al. Comparison of risk stratification tools in predicting outcomes of patients with higher-risk myelodysplastic syndromes treated with azanucleosides. Leukemia 30, 649–657 (2016). https://doi.org/10.1038/leu.2015.283

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