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Which prognostic score in MDS? Both!

Leukemia volume 29, page 1447 (2015)Cite this article

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Myelodysplastic syndromes (MDS) can be considered as one of the most heterogeneous hematological diseases reflected not only by the variety of clinical manifestations, but also by the great differences in survival and incidences of acute myeloid leukemia (AML) among individual patients. Whereas some patients succumb to complications of bone marrow failure or leukemia development shortly after diagnosis, others show a relatively indolent disease course and may survive for several years with supportive care only. Therefore, prognostication and choice of treatment should be based on reliable risk stratification.

Historically, prognostic scoring of patients started by the FAB (French–American–British) classification allowing for a very simple tool to predict prognosis. This was followed by a pivotal system named ‘International Prognostic Scoring System’ (IPSS) incorporating for the first time cytogenetic markers.1 The IPSS quickly developed into a tool, on which the majority of clinical trials in MDS are historically based, so that it still continues to be the most widely accepted scoring system for estimating the prognosis of untreated patients with MDS and with up to 30% bone marrow blasts. Patients with IPSS low or int-1 are usually defined as ‘lower-risk’ MDS and corresponding therapies aim at the relief of cytopenia and the improvement of quality of life. On the other hand ‘higher-risk’ patients according to IPSS (int-2 or high) are mostly treated with hypomethylating agents or intensive approaches from diagnosis on in order to change the natural course of the disease. The subsequent classification of MDS by the World Health Organization (WHO) allowed for a distinction between pure refractory anemia and refractory anemia with ringed sideroblasts, patients with multi-lineage dysplasia and those with blast excess up to 20% in the bone marrow. Moreover, it transferred patients with an isolated deletion of 5q into a separate category. This definition has proven extremely valuable as, for the first time, a genetic marker lesion also constituted a target for biological therapy (lenalidomide).

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References

  1. Greenberg P, Cox C, LeBeau MM, Fenaux P, Morel P, Sanz G . International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood 1997; 89: 2079–2088.

    CAS  PubMed  Google Scholar 

  2. Malcovati L, Germing U, Kuendgen A, Della Porta MG, Pascutto C, Invernizzi R et al. Time-dependent prognostic scoring system for predicting survival and leukemic evolution in myelodysplastic syndromes. J Clin Oncol 2007; 25: 3503–3510.

    Article  Google Scholar 

  3. Greenberg PL, Tuechler H, Schanz J, Sanz G, Garcia-Manero G, Sole F et al. Revised international prognostic scoring system for myelodysplastic syndromes. Blood 2012; 120: 2454–2465.

    Article  CAS  Google Scholar 

  4. Della Porta MG, Tuechler H, Malcovati L, Schanz J, Sanz G, Garcia-Manero G et al. Validation of WHO classification-based Prognostic Scoring System (WPSS) for myelodysplastic syndromes and comparison with the revised International Prognostic Scoring System (IPSS-R). A study of the International Working Group for Prognosis in Myelodysplasia (IWG-PM). Leukemia 2015; 29: 1502–1513.

    Article  CAS  Google Scholar 

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  1. Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus an der Technischen Universität, Dresden, Germany

    U Platzbecker

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Correspondence to U Platzbecker.

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Platzbecker, U. Which prognostic score in MDS? Both!. Leukemia 29, 1447 (2015). https://doi.org/10.1038/leu.2015.92

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