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Nakamura M, Imamura T, Hida Y, Izumida T, Nakagaito M, Nagura S, Doi T, Fukahara K, Kinugawa K. A case of destination therapy for post-fulminant myocarditis with myelodysplastic syndrome. J Artif Organs 2025; 28:30-35. [PMID: 38862744 DOI: 10.1007/s10047-024-01455-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/02/2024] [Indexed: 06/13/2024]
Abstract
We encountered a 64-year-old woman who experienced fulminant myocarditis and underwent treatment with veno-arterial extracorporeal membrane oxygenation and Impella CP support. Subsequently, she underwent a device upgrade to Impella 5.5 and received continuous hemodiafiltration for 3 months. During mechanical circulatory support, she developed refractory anemia and thrombocytopenia, leading to a diagnosis of myelodysplastic syndrome. Following the removal of the devices, she no longer required blood transfusions. She received HeartMate 3 left ventricular assist device implantation as a destination therapy indication despite the presence of myelodysplastic syndrome. She was successfully managed by aspirin-free antithrombotic therapy without any hemocompatibility-related adverse events for 4 months after index discharge on foot. We present a patient with a unique and rare presentation, wherein HeartMate 3 was implanted and successfully managed without aspirin to prevent bleeding complications associated with myelodysplastic syndrome.
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Affiliation(s)
- Makiko Nakamura
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan.
| | - Yuki Hida
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Toshihide Izumida
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Masaki Nakagaito
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Saori Nagura
- Department of Cardiovascular Surgery, University of Toyama, Toyama, Toyama, Japan
| | - Toshio Doi
- Department of Cardiovascular Surgery, University of Toyama, Toyama, Toyama, Japan
| | - Kazuaki Fukahara
- Department of Cardiovascular Surgery, University of Toyama, Toyama, Toyama, Japan
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
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2
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Larfors G, Moreno Berggren D, Garelius H, Nilsson L, Rasmussen B, Hellström-Lindberg E, Ejerblad E. MDS-Comorbidity Index using register data has prognostic impact in Swedish MDS patients. Leuk Res 2023; 134:107386. [PMID: 37690322 DOI: 10.1016/j.leukres.2023.107386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/12/2023]
Abstract
Comorbidities influence the mortality in patients with myelodysplastic syndromes, and a growing body of evidence suggest that comorbidity history should be used in addition to established prognostic indices. A comorbidity index specific for MDS, the MDS-CI, was introduced a decade ago. In this study we aim to construct an MDS-CI version based on diagnoses from register data only, to expand its use beyond the clinical setting to retrospective and register based studies. We further test this version on a Swedish population-based MDS cohort of 2947 patients, and compare its prognostic accuracy to that of Charlson Comorbidity Index. Our register based MDS-CI divided patients into three risk groups of similar proportions as have been published for the original MDS-CI. Compared to low risk patients, intermediate and high risk patients had 50 % and 70 % higher mortality, respectively. The prognostic value of MDS-CI was equal to that of Charlson comorbidity index. Adding MDS-CI to the established prognostic factors IPSS-R and age increased the prognostic accuracy. In summary, we demonstrate that MDS-CI can be adequately estimated from diagnoses recorded in registers only, and that it is a useful tool in any future study on myelodysplastic syndromes with a need to adjust for comorbidities.
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Affiliation(s)
- Gunnar Larfors
- Unit of Haematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Daniel Moreno Berggren
- Unit of Haematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Hege Garelius
- Section of Haematology and Coagulation, Department of Specialist Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Nilsson
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Bengt Rasmussen
- Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Eva Hellström-Lindberg
- Centre for Haematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth Ejerblad
- Unit of Haematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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3
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Mozessohn L, Li Q, Liu N, Leber B, Khalaf D, Sabloff M, Christou G, Yee K, Chodirker L, Parmentier A, Siddiqui M, Mamedov A, Zhang L, Liu Y, Earle CC, Cheung MC, Mittmann N, Buckstein R. Impact of Frailty on Health Care Resource Utilization and Costs of Care in Myelodysplastic Syndromes. JCO Oncol Pract 2023; 19:e559-e569. [PMID: 36763927 PMCID: PMC10101507 DOI: 10.1200/op.22.00668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/17/2022] [Accepted: 12/29/2022] [Indexed: 02/12/2023] Open
Abstract
PURPOSE The role of frailty in affecting survival in myelodysplastic syndromes (MDS) is increasingly recognized. Despite this, a paucity of data exists on the association between frailty and other clinically meaningful outcomes including health care resource utilization and costs of care. METHODS We linked the Ontario subset of the prospective Canadian MDS registry (including baseline patient/disease characteristics) to population-based health system administrative databases. Baseline frailty was calculated from the 15-item MDS-specific frailty scale (FS-15). Primary outcomes were public health care utilization and 30-day standardized costs of care (2019 Canadian dollars) determined for each phase of disease (initial, continuation, and terminal phases). Negative binomial regression was used to assess the association between frailty and health care costs with Poisson regression to explore predictors of hospitalization. RESULTS Among 461 patients with complete FS-15 scores, 374 (81.1%) had a hospitalization with a mean length of stay of 10.6 days. Controlling for age, comorbidities, Revised International Prognostic Scoring System, and transfusion dependence, the FS-15 was independently associated with hospitalization during the initial (P = .02) and continuation (P = .01) phases but not the terminal disease phase (P = .09). The mean 30-day standardized cost per patient was $8,499 (median, $6,295; interquartile range, $2,798-$11,996), largely driven by cancer clinic visits and hospitalization. On multivariable analysis, the FS-15 was independently associated with costs of care during the initial disease phase (P = .02). CONCLUSION We demonstrate an association between frailty and clinically meaningful outcomes including hospitalization and costs of care in patients with MDS. Our results suggest that baseline frailty may help to inform patients and physicians of expected outcomes.
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Affiliation(s)
- Lee Mozessohn
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Qing Li
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
| | - Ning Liu
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
| | - Brian Leber
- Division of Hematology, Juravinski Cancer Center, Hamilton, ON, Canada
| | - Dina Khalaf
- Division of Hematology, Juravinski Cancer Center, Hamilton, ON, Canada
| | - Mitchell Sabloff
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Grace Christou
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Karen Yee
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lisa Chodirker
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Anne Parmentier
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Mohammed Siddiqui
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alexandre Mamedov
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Liying Zhang
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ying Liu
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
| | - Craig C. Earle
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Matthew C. Cheung
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nicole Mittmann
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Pharmacology and Toxicology and Institute for Health, Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Rena Buckstein
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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4
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Thomopoulos TP, Pappa V, Papageorgiou SG. Comorbidities and frailty predict outcome of patients with myelodysplastic syndromes. Should we integrate them in novel prognostic scoring systems? J Geriatr Oncol 2021; 12:1122-1129. [PMID: 33771514 DOI: 10.1016/j.jgo.2021.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/04/2021] [Accepted: 03/17/2021] [Indexed: 12/11/2022]
Abstract
Prognosis of myelodysplastic syndromes (MDS) is based on scoring systems focusing on disease-related factors; however, several studies have shown that patient-related factors might be equally important in prognostication of patients with malignancies in general but also for patients with MDS. The aim of this review was to evaluate the role of comorbidities and frailty as prognostic factors as well as predictive factors of response and tolerability to hypomethylating agents. Both comorbidities and frailty were shown to be predictive of overall survival; however, they mostly correlate with risk for non-leukemic death rather than leukemia-free survival. In patients with higher-risk MDS, comorbidities burden and frailty might be predictive of poor treatment response as well as increased toxicity. In this context, all patients with MDS should be evaluated for comorbidities and frailty at baseline, preferentially using indices validated for MDS. This assessment should guide the selection of treatment. Decision regarding treatment initiation should be based on disease-related factors as captured by the established prognostic scoring systems.
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Affiliation(s)
- Thomas P Thomopoulos
- 2nd Department of Internal Medicine and Research Unit, Hematology Unit, University General Hospital "Attikon", Haidari, Athens, Greece
| | - Vasiliki Pappa
- 2nd Department of Internal Medicine and Research Unit, Hematology Unit, University General Hospital "Attikon", Haidari, Athens, Greece
| | - Sotirios G Papageorgiou
- 2nd Department of Internal Medicine and Research Unit, Hematology Unit, University General Hospital "Attikon", Haidari, Athens, Greece.
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5
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Karantanos T, Jain T, Moliterno AR, Jones RJ, DeZern AE. Sex-Related Differences in Chronic Myeloid Neoplasms: From the Clinical Observation to the Underlying Biology. Int J Mol Sci 2021; 22:2595. [PMID: 33807519 PMCID: PMC7961949 DOI: 10.3390/ijms22052595] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 12/11/2022] Open
Abstract
Chronic myeloid neoplasms are clonal diseases with variable clinical course and outcomes and despite the introduction of novel therapies, patients with high-risk disease continue to have overall poor outcomes. Different groups have highlighted that men have overall worse survival and higher incidence of transformation to acute leukemia compared to women across neoplasms such as myelodysplastic syndrome (MDS), myeloproliferative neoplasms (MPN), MDS/MPN overlap neoplasms, and CML. More recent studies evaluating the genomic profile of patients with these neoplasms demonstrated a male predominance for mutations in high-risk genes including ASXL1, U2AF1, SRSF2 and ZRSR2. The understanding of the underlying biology is limited but a number of hypotheses have been developed and are currently being investigated. This review summarizes the current knowledge about sex-related differences in the clinical outcomes and genomic profile of patients with chronic myeloid neoplasms and discusses the hypothesized biologic mechanisms as an attempt to explain these observations.
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MESH Headings
- Animals
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Mutation/genetics
- Myelodysplastic Syndromes/genetics
- Myelodysplastic Syndromes/pathology
- Myeloproliferative Disorders/genetics
- Myeloproliferative Disorders/pathology
- Sex Characteristics
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Affiliation(s)
- Theodoros Karantanos
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD 21231, USA; (T.J.); (R.J.J.); (A.E.D.)
| | - Tania Jain
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD 21231, USA; (T.J.); (R.J.J.); (A.E.D.)
| | - Alison R. Moliterno
- Division of Adult Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21231, USA;
| | - Richard J. Jones
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD 21231, USA; (T.J.); (R.J.J.); (A.E.D.)
| | - Amy E. DeZern
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD 21231, USA; (T.J.); (R.J.J.); (A.E.D.)
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6
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Fang Y, Guo J, Wu D, Wu LY, Song LX, Zhang Z, Zhao YS, Chang CK. Integration Analysis of JAK2 or RUNX1 Mutation With Bone Marrow Blast Can Improve Risk Stratification in the Patients With Lower Risk Myelodysplastic Syndrome. Front Oncol 2021; 10:610525. [PMID: 33520721 PMCID: PMC7839382 DOI: 10.3389/fonc.2020.610525] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/10/2020] [Indexed: 11/13/2022] Open
Abstract
Despite the improvements in prognostication of the revised International Prognostic Scoring System (IPSS-R) in myelodysplastic syndrome (MDS), there remain a portion of patients with lower risk (low/intermediate risk, LR) but poor prognostics. This study aimed to evaluate the relative contribution of mutational status when added to the IPSS-R, for estimating overall survival (OS) and progression-free survival (PFS) in patients with LR-MDS. We retrospectively analyzed clinical and laboratory variables of 328 patients diagnosed with MDS according to the FAB criteria. Twenty-nine-gene NGS assay was applied to bone marrow samples obtained at diagnosis. 233 (71.04%) patients were classified as LR-MDS. Univariate analysis showed association between inferior outcome (OS and PFS) and presence of JAK2 (p = 0.0177, p = 0.0002), RUNX1 (p = 0.0250, p = 0.0387), and U2AF1 (p = 0.0227, p = 0.7995) mutations. Multivariable survival analysis revealed JAK2 (p < 0.0001) and RUNX1 (p = 0.0215) mutations were independently prognostic for PFS in LR-MDS. Interestingly, bone marrow blast >1.5% could further predict disease progression of patients with LR-MDS (HR 8.06, 95%CI 2.95–22.04, p < 0.0001). Incorporation of JAK2, RUNX1 mutation and bone marrow blast in the IPSS-R can improve risk stratification in patients with LR-MDS. In summary, our result provided new risk factors for LR-MDS prognostics to identify candidates for early therapeutic intervention.
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Affiliation(s)
- Ying Fang
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Juan Guo
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Dong Wu
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ling-Yun Wu
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Lu-Xi Song
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zheng Zhang
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - You-Shan Zhao
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chun-Kang Chang
- Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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7
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Du MY, Xu M, Deng J, Liu L, Guo T, Xia LH, Hu Y, Mei H. Evaluation of different scoring systems and gene mutations for the prognosis of myelodysplastic syndrome (MDS) in Chinese population. J Cancer 2020; 11:508-519. [PMID: 31897246 PMCID: PMC6930433 DOI: 10.7150/jca.30363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 09/14/2019] [Indexed: 11/25/2022] Open
Abstract
MDS is a heterogeneous disease with diverse clinical manifestations, and an effective prognostic evaluation tool for MDS patients is needed. To achieve more accurate prognosis assessment for Chinese MDS patients, here we examined several scoring systems and explored the implications of gene mutations. The prognostic conditions were stratified against three different score systems (International Prognostic Scoring System (IPSS), WHO Prognostic Scoring System (WPSS), and Revised International Prognostic Scoring System (IPSS-R)) were retrospectively applied to 110 de novo MDS patients in study cohort in our hospital and the prognostic conditions were stratified respectively. IPSS-R out-performed the others, since it had less overlaps in survival curve, especially in the relatively low-risk group. Furthermore, genetic mutations were identified in 84 out of 110 patients and their association with overall survival (OS) were determined. Among them, sixty-three percent patients had at least one-point mutation, including thirty-five patients with normal karyotypes. The presence of TP53 mutations, but not TET2, DNMT3A or ASXL1 mutations was significantly correlated with shorter OS. A new model incorporating IPSS-R and TP53 mutations into survival analysis was proposed, and the prognostic value of this model was validated to be predominant in a 190-primary MDS patient independent cohort. Our data suggested that IPSS-R was more suitable for Chinese population. Attentions should be paid to the unfavourable mutations that might exert impact on the survival, especially in patients with relatively low risk.
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Affiliation(s)
- Meng-Yi Du
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Min Xu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jun Deng
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Lin Liu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Tao Guo
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ling-Hui Xia
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Wuhan, Hubei 430022, PR China
| | - Heng Mei
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Wuhan, Hubei 430022, PR China
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8
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Buckstein RJ. Integrating patient-centered factors in the risk assessment of MDS. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:373-380. [PMID: 31808887 PMCID: PMC6913474 DOI: 10.1182/hematology.2019000041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Myelodysplastic syndromes are clonal myeloid neoplasms that primarily present in older adults. Although leukemia develops in approximately 25% to 30% of individuals, the significantly shortened survival in this population is attributed more commonly to nonleukemic causes. The current prognostic scoring systems for leukemia and overall survival based on disease characteristics are becoming increasingly sophisticated and accurate with the incorporation of molecular data. The addition of patient-related factors such as comorbidity, disability, frailty, and fatigue to these new models may improve their predictive power for overall survival, treatment toxicity, and health care costs. To improve the generalizability of clinical trial results to the real world, geriatric assessment testing should become a standard of care in MDS clinical trials.
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Affiliation(s)
- Rena J Buckstein
- Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, ON, Canada
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9
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McDonald LS, McCarthy P, Khan M, Hogan P, Kelleher E, Murphy PT, Quinn J, Desmond R, McHugh J, Strickland M, O'Connell E, Cahill M, Maung SW, Keohane C, O'Neill D, Ryan D, Mykytiv V, Enright H. A multicenter report on the natural history of myelodysplastic syndromes in very old patients (aged over 85 years). Leuk Lymphoma 2019; 60:1324-1327. [DOI: 10.1080/10428194.2018.1538513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Peter McCarthy
- Haematology, Cork University Hospital and University College Cork, Cork, Ireland
| | | | - Patrick Hogan
- Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | | | | | - John Quinn
- Haematology, Beaumont Hospital, Dublin, Ireland
| | - Ronan Desmond
- Haematology, Tallaght University Hospital, Dublin, Ireland
| | - John McHugh
- Haematology, Tallaght University Hospital, Dublin, Ireland
| | | | | | - Mary Cahill
- Haematology, Cork University Hospital and University College Cork, Cork, Ireland
| | - Su W. Maung
- Haematology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Desmond O'Neill
- Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Dan Ryan
- Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Vitaliy Mykytiv
- Haematology, Cork University Hospital and University College Cork, Cork, Ireland
| | - Helen Enright
- Haematology, Tallaght University Hospital, Dublin, Ireland
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10
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Itonaga H, Ishiyama K, Aoki K, Aoki J, Ishikawa T, Uchida N, Ohashi K, Ueda Y, Fukuda T, Sakura T, Ohno Y, Iwato K, Okumura H, Kondo T, Ichinohe T, Takanashi M, Atsuta Y, Miyazaki Y. Increased opportunity for prolonged survival after allogeneic hematopoietic stem cell transplantation in patients aged 60-69 years with myelodysplastic syndrome. Ann Hematol 2019; 98:1367-1381. [PMID: 30854574 DOI: 10.1007/s00277-019-03653-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 03/02/2019] [Indexed: 12/27/2022]
Abstract
We conducted a nationwide retrospective study to evaluate the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in 651 patients aged 60-69 years with de novo myelodysplastic syndrome (MDS). We divided patients into two groups: 152 and 499 patients with an early and advanced disease status, respectively. The 3-year overall survival (OS) rate of patients with an early disease status was 45.9% (95% confidence interval [CI], 37.0 to 54.2%). A multivariate analysis revealed five adverse factors for OS: performance status (PS) 2-4 (hazard ratio [HR] 4.48; P < .001), poor cytogenetic risk group (HR 1.83; P = .041), male recipient (HR 2.58; P = .003), use of HLA-mismatched related grafts (HR 4.75; P = .003), and unrelated cord blood (HR 2.47; P = .023). The 3-year OS rate of patients with an advanced disease status was 37.2% (95% CI 32.4 to 41.9%). Five factors correlated with worse OS: PS 2-4 (HR 1.72; P = .003), poor cytogenetic risk group (HR 1.49; P = .003), use of HLA-mismatched related grafts (HR 1.96; P = .015), unrelated cord blood (HR 2.05; P < .001), and the high number of red blood cell transfusions before transplantation (HR 1.85; P = .018). The present results revealed the more frequent utilization of allo-HSCT for MDS patients aged 60-69 years, which increases the curative potential.
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Affiliation(s)
- Hidehiro Itonaga
- Department of Hematology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Japan.
| | - Ken Ishiyama
- Department of Hematology, Kanazawa University Hospital, Kanazawa, Japan
| | - Kazunari Aoki
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jun Aoki
- Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan
| | - Takayuki Ishikawa
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Naoyuki Uchida
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan
| | - Kazuteru Ohashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yasunori Ueda
- Department of Hematology/Oncology and Transfusion and Hemapheresis Center, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Toru Sakura
- Leukemia Research Center, Saiseikai Maebashi Hospital, Maebashi, Gunma, Japan
| | - Yuju Ohno
- Department of Internal Medicine, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Koji Iwato
- Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Hirokazu Okumura
- Department of Internal Medicine (Hematology), Toyama Prefectural Central Hospital, Toyama, Japan
| | - Tadakazu Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Minoko Takanashi
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.,Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasushi Miyazaki
- Department of Hematology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Japan.,Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
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11
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Benton CB, Khan M, Sallman D, Nazha A, Nogueras González GM, Piao J, Ning J, Aung F, Al Ali N, Jabbour E, Kadia TM, Borthakur G, Ravandi F, Pierce S, Steensma D, DeZern A, Roboz G, Sekeres M, Andreeff M, Kantarjian H, Komrokji RS, Garcia-Manero G. Prognosis of patients with intermediate risk IPSS-R myelodysplastic syndrome indicates variable outcomes and need for models beyond IPSS-R. Am J Hematol 2018; 93:1245-1253. [PMID: 30051599 DOI: 10.1002/ajh.25234] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 01/01/2023]
Abstract
The International Prognostic Scoring System-Revised (IPSS-R) is one standard for myelodysplastic syndrome (MDS) risk stratification. It divides patients into five categories including an intermediate subset (IPSS-R int-risk). Outcomes and clinical interventions for patients with IPSS-R int-risk are not well defined. We performed an analysis of outcomes of this group of patients. Out of 3167 patients, a total of 298 were identified with IPSS-R int-risk MDS and retrospectively analyzed to assess characteristics affecting outcomes. Cox proportional hazard models for overall survival (OS) were performed to identify statistically significant clinical factors that influence survival. Age of 66 years or greater, peripheral blood blasts of 2% or more, and history of red blood cell (RBC) transfusion were significantly associated with inferior survival. Based on these features, MDS patients with IPSS-R int-risk were classified into two prognostic risk groups for analysis, an int-favorable group and an int-adverse group, and had significantly divergent outcomes. Sequential prognostication was validated using two independent datasets comprising over 700 IPSS-R int-risk patients. The difference in median survival between int-favorable and int-adverse patients was 3.7 years in the test cohort, and 1.8 and 2.0 years in the two validation cohorts. These results confirm significantly variable outcomes of patients with IPSS-R int-risk and need for different prognostic systems.
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Affiliation(s)
- Christopher B. Benton
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Maliha Khan
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - David Sallman
- Department of Malignant Hematology; H. Lee Moffitt Cancer Center; Tampa Florida
| | - Aziz Nazha
- Department of Leukemia; Cleveland Clinic; Cleveland Ohio
| | | | - Jin Piao
- Department of Statistics; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jing Ning
- Department of Statistics; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Fleur Aung
- Laboratory Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Najla Al Ali
- Department of Malignant Hematology; H. Lee Moffitt Cancer Center; Tampa Florida
| | - Elias Jabbour
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Tapan M. Kadia
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Gautam Borthakur
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Farhad Ravandi
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Sherry Pierce
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - David Steensma
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston
| | - Amy DeZern
- Sidney Kimmel Comprehensive Cancer Center; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Gail Roboz
- Joan and Sanford I. Weill Department of Medicine; Weill Cornell Medical; New York New York
| | | | - Michael Andreeff
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Hagop Kantarjian
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Rami S. Komrokji
- Department of Malignant Hematology; H. Lee Moffitt Cancer Center; Tampa Florida
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12
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Part 2: Myelodysplastic syndromes - classification systems. Hematol Transfus Cell Ther 2018; 40:262-266. [PMID: 30128436 PMCID: PMC6098184 DOI: 10.1016/j.htct.2018.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 01/08/2023] Open
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13
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Luskin MR, Abel GA. Management of older adults with myelodysplastic syndromes (MDS). J Geriatr Oncol 2018; 9:302-307. [DOI: 10.1016/j.jgo.2017.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/17/2017] [Accepted: 12/13/2017] [Indexed: 01/09/2023]
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14
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Moreno Berggren D, Folkvaljon Y, Engvall M, Sundberg J, Lambe M, Antunovic P, Garelius H, Lorenz F, Nilsson L, Rasmussen B, Lehmann S, Hellström-Lindberg E, Jädersten M, Ejerblad E. Prognostic scoring systems for myelodysplastic syndromes (MDS) in a population-based setting: a report from the Swedish MDS register. Br J Haematol 2018; 181:614-627. [PMID: 29707769 DOI: 10.1111/bjh.15243] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 02/16/2018] [Indexed: 01/22/2023]
Abstract
The myelodysplastic syndromes (MDS) have highly variable outcomes and prognostic scoring systems are important tools for risk assessment and to guide therapeutic decisions. However, few population-based studies have compared the value of the different scoring systems. With data from the nationwide Swedish population-based MDS register we validated the International Prognostic Scoring System (IPSS), revised IPSS (IPSS-R) and the World Health Organization (WHO) Classification-based Prognostic Scoring System (WPSS). We also present population-based data on incidence, clinical characteristics including detailed cytogenetics and outcome from the register. The study encompassed 1329 patients reported to the register between 2009 and 2013, 14% of these had therapy-related MDS (t-MDS). Based on the MDS register, the yearly crude incidence of MDS in Sweden was 2·9 per 100 000 inhabitants. IPSS-R had a significantly better prognostic power than IPSS (P < 0·001). There was a trend for better prognostic power of IPSS-R compared to WPSS (P = 0·05) and for WPSS compared to IPSS (P = 0·07). IPSS-R was superior to both IPSS and WPSS for patients aged ≤70 years. Patients with t-MDS had a worse outcome compared to de novo MDS (d-MDS), however, the validity of the prognostic scoring systems was comparable for d-MDS and t-MDS. In conclusion, population-based studies are important to validate prognostic scores in a 'real-world' setting. In our nationwide cohort, the IPSS-R showed the best predictive power.
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Affiliation(s)
- Daniel Moreno Berggren
- Department of Medical Science, Section of Haematology, Uppsala University, Uppsala, Sweden
| | - Yasin Folkvaljon
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Marie Engvall
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Johan Sundberg
- Department of Medical Science, Section of Haematology, Uppsala University, Uppsala, Sweden
| | - Mats Lambe
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Petar Antunovic
- Department of Haematology, Linköping University Hospital, Linköping, Sweden
| | - Hege Garelius
- Section for Haematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Fryderyk Lorenz
- Department of Medical Biosciences, Umeå University, Umeå, Sweden
| | - Lars Nilsson
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Bengt Rasmussen
- School of Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - Sören Lehmann
- Department of Medical Science, Section of Haematology, Uppsala University, Uppsala, Sweden
| | - Eva Hellström-Lindberg
- Centre for Haematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Jädersten
- Centre for Haematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth Ejerblad
- Department of Medical Science, Section of Haematology, Uppsala University, Uppsala, Sweden
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15
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16
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Ramos F, Robledo C, Pereira A, Pedro C, Benito R, de Paz R, del Rey M, Insunza A, Tormo M, Díez-Campelo M, Xicoy B, Salido E, Sánchez-del-Real J, Arenillas L, Florensa L, Luño E, del Cañizo C, Sanz GF, María Hernández-Rivas J. Multidimensional assessment of patient condition and mutational analysis in peripheral blood, as tools to improve outcome prediction in myelodysplastic syndromes: A prospective study of the Spanish MDS group. Am J Hematol 2017; 92:E534-E541. [PMID: 28612357 DOI: 10.1002/ajh.24813] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 06/04/2017] [Accepted: 06/05/2017] [Indexed: 12/13/2022]
Abstract
The International Prognostic Scoring System and its revised form (IPSS-R) are the most widely used indices for prognostic assessment of patients with myelodysplastic syndromes (MDS), but can only partially account for the observed variation in patient outcomes. This study aimed to evaluate the relative contribution of patient condition and mutational status in peripheral blood when added to the IPSS-R, for estimating overall survival and the risk of leukemic transformation in patients with MDS. A prospective cohort (2006-2015) of 200 consecutive patients with MDS were included in the study series and categorized according to the IPSS-R. Patients were further stratified according to patient condition (assessed using the multidimensional Lee index for older adults) and genetic mutations (peripheral blood samples screened using next-generation sequencing). The change in likelihood-ratio was tested in Cox models after adding individual covariates. The addition of the Lee index to the IPSS-R significantly improved prediction of overall survival [hazard ratio (HR) 3.02, 95% confidence interval (CI) 1.96-4.66, P < 0.001), and mutational analysis significantly improved prediction of leukemic evolution (HR 2.64, 1.56-4.46, P < 0.001). Non-leukemic death was strongly linked to patient condition (HR 2.71, 1.72-4.25, P < 0.001), but not to IPSS-R score (P = 0.35) or mutational status (P = 0.75). Adjustment for exposure to disease-modifying therapy, evaluated as a time-dependent covariate, had no effect on the proposed model's predictive ability. In conclusion, patient condition, assessed by the multidimensional Lee index and patient mutational status can improve the prediction of clinical outcomes of patients with MDS already stratified by IPSS-R.
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Affiliation(s)
- Fernando Ramos
- Department of Hematology; Hospital Universitario de León; León Spain
- Institute of Biomedicine (IBIOMED, León); León Spain
| | - Cristina Robledo
- Unidad de Diagnóstico Molecular y Celular del Cáncer, IBSAL, IBMCC-Centro de Investigación del Cáncer (USAL-CSIC); Salamanca Spain
| | - Arturo Pereira
- Department of Blood Transfusion; Hospital Clínic i Provincial; Barcelona Spain
| | - Carmen Pedro
- Department of Hematology; Hospital del Mar; Barcelona Spain
| | - Rocío Benito
- Unidad de Diagnóstico Molecular y Celular del Cáncer, IBSAL, IBMCC-Centro de Investigación del Cáncer (USAL-CSIC); Salamanca Spain
| | - Raquel de Paz
- Department of Hematology; Hospital Universitario La Paz; Madrid Spain
| | - Mónica del Rey
- Unidad de Diagnóstico Molecular y Celular del Cáncer, IBSAL, IBMCC-Centro de Investigación del Cáncer (USAL-CSIC); Salamanca Spain
| | - Andrés Insunza
- Department of Hematology; Hospital Universitario Marqués de Valdecilla; Santander Spain
| | - Mar Tormo
- Department of Hematology and Oncology; Hospital Clínico de Valencia; Valencia Spain
| | - María Díez-Campelo
- Department of Hematology; Hospital Universitario de Salamanca; Salamanca Spain
| | - Blanca Xicoy
- Department of Hematology, Institut Català d'Oncologia-Hospital Universitari Germans Trias i Pujol, Badalona, Josep Carreras Leukemia Research Institute; Badalona Spain
| | - Eduardo Salido
- Department of Hematology; Hospital Universitario La Arrixaca; Murcia Spain
| | | | | | | | - Elisa Luño
- Department of Hematology; Hospital Universitario Central de Asturias; Oviedo Spain
| | - Consuelo del Cañizo
- Department of Hematology; Hospital Universitario de Salamanca; Salamanca Spain
| | - Guillermo F. Sanz
- Department of Hematology Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - Jesús María Hernández-Rivas
- Unidad de Diagnóstico Molecular y Celular del Cáncer, IBSAL, IBMCC-Centro de Investigación del Cáncer (USAL-CSIC); Salamanca Spain
- Department of Hematology; Hospital Universitario de Salamanca; Salamanca Spain
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17
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Bartoszko J, Panzarella T, McNamara CJ, Lau A, Schimmer AD, Schuh AC, Sibai H, Maze D, Yee KWL, Devlin R, Gupta V. Distribution and Impact of Comorbidities on Survival and Leukemic Transformation in Myeloproliferative Neoplasm-Associated Myelofibrosis: A Retrospective Cohort Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:774-781. [PMID: 28711573 DOI: 10.1016/j.clml.2017.06.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND We sought to describe the distribution and impact of comorbidities on outcomes in patients with myelofibrosis, a disease characterized by aberrant bone marrow function with eventual fibrosis. Comorbidities were scored using the Adult Comorbidity Evaluation-27 (ACE-27) and the Hematopoietic Cell Transplant Comorbidity Index (HCT-CI), in which a score ≥ 3 indicates severe comorbidities. PATIENTS AND METHODS We conducted a retrospective study of 306 patients with a confirmed diagnosis of myelofibrosis. Patients were seen from 1999 to 2014 with a median follow-up of 2 years. Multivariable Cox proportional hazards models were constructed to assess the impact of comorbidities on overall survival and leukemic transformation from the date of presentation to our center. A series of descriptive analyses were performed examining the distribution of comorbidities captured by the scales. RESULTS On multivariable survival analysis, an ACE-27 score of 3 was associated with an almost twofold increase in the risk of all-cause death (hazard ratio [HR] 1.95; 95% confidence interval [CI], 1.06-3.58; P = .03) compared with a lower score of 0 to 1. An HCT-CI score ≥ 3 was marginally significantly associated with an increased risk of all-cause death (HR 1.60; 95% CI 0.96-2.68; P = .07). ACE-27 captured a greater spectrum of cardiovascular and venous thrombotic disease. No impact of comorbidities on leukemic transformation was observed. CONCLUSIONS Although the presence of severe comorbidities was lower when assessed by ACE-27 (13%) compared with HCT-CI (23%), and the spectrums of comorbidities captured were different, the overall impact of severe comorbidities as assessed by both scales appears to be similar and associated with a survival disadvantage.
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Affiliation(s)
- Justyna Bartoszko
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Tony Panzarella
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Caroline Jane McNamara
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Anthea Lau
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Aaron D Schimmer
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Andre C Schuh
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Hassan Sibai
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dawn Maze
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Karen W L Yee
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Devlin
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Vikas Gupta
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
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18
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Kawabata H, Tohyama K, Matsuda A, Araseki K, Hata T, Suzuki T, Kayano H, Shimbo K, Zaike Y, Usuki K, Chiba S, Ishikawa T, Arima N, Nogawa M, Ohta A, Miyazaki Y, Mitani K, Ozawa K, Arai S, Kurokawa M, Takaori-Kondo A. Validation of the revised International Prognostic Scoring System in patients with myelodysplastic syndrome in Japan: results from a prospective multicenter registry. Int J Hematol 2017; 106:375-384. [DOI: 10.1007/s12185-017-2250-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/08/2017] [Accepted: 05/09/2017] [Indexed: 02/08/2023]
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19
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van Spronsen MF, Witte BI, Ossenkoppele GJ, Westers TM, van de Loosdrecht AA. Response to letter commenting on: Prognostic relevance of morphological classification models for myelodysplastic syndromes in an era of the revised International Prognostic Scoring System. Eur J Cancer 2017; 72:269-271. [PMID: 28057399 DOI: 10.1016/j.ejca.2016.11.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 11/19/2016] [Indexed: 11/19/2022]
Affiliation(s)
- M F van Spronsen
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands.
| | - B I Witte
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - G J Ossenkoppele
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - T M Westers
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
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20
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Falantes JF, Márquez-Malaver FJ, Knight T, Calderón-Cabrera C, Martino ML, González J, Montero I, Espigado I, Pérez-Simón JA. The incorporation of comorbidities in the prognostication of patients with lower-risk myelodysplastic syndrome*. Leuk Lymphoma 2016; 58:1893-1902. [DOI: 10.1080/10428194.2016.1267350] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Jose F. Falantes
- Department of Hematology, Hospital Universitario Virgen del Rocío, Sevilla. Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Spain
| | - Francisco J. Márquez-Malaver
- Department of Hematology, Hospital Universitario Virgen del Rocío, Sevilla. Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Spain
| | - Teresa Knight
- Department of Hematology, Hospital Universitario Virgen del Rocío, Sevilla. Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Spain
| | - Cristina Calderón-Cabrera
- Department of Hematology, Hospital Universitario Virgen del Rocío, Sevilla. Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Spain
| | - María L. Martino
- Department of Hematology, Hospital Universitario Virgen del Rocío, Sevilla. Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Spain
| | - Jose González
- Department of Hematology, Hospital Universitario Virgen del Rocío, Sevilla. Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Spain
| | - Isabel Montero
- Department of Hematology, Hospital Universitario Virgen del Rocío, Sevilla. Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Spain
| | - Ildefonso Espigado
- Department of Hematology, Hospital Universitario Virgen del Rocío, Sevilla. Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Spain
| | - Jose A. Pérez-Simón
- Department of Hematology, Hospital Universitario Virgen del Rocío, Sevilla. Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Spain
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21
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Bruch HR, Dencausse Y, Heßling J, Michl G, Schlag R, Skorupa A, Schneider-Schranz C, Wolf S, Schulte C, Tesch H. CONIFER - Non-Interventional Study to Evaluate Therapy Monitoring During Deferasirox Treatment of Iron Toxicity in Myelodysplastic Syndrome Patients with Transfusional Iron Overload. Oncol Res Treat 2016; 39:424-31. [PMID: 27486873 DOI: 10.1159/000447035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/20/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The non-interventional study CONIFER was designed to assess the safety and clinical practicability of deferasirox for the treatment of transfusional iron overload in myelodysplastic syndrome (MDS) patients. METHODS Patients included in the study were diagnosed with MDS and received at least 1 treatment with deferasirox. The observation period covered the time from the initial visit until the last follow-up. RESULTS The data of 99 patients with MDS scored mainly as International Prognostic Scoring System (IPSS) low and intermediate 1 were evaluated. The mean age of the participants was 75 years and 58% of the patients were male. Iron overload was assessed by serum ferritin level (mean baseline serum ferritin 2,080 ± 1,244 µg/l). Patients were treated for a mean duration of 16 months (mean daily dose at baseline 11.8 ± 7.0 mg/kg). Stratification of serum ferritin levels by deferasirox dose showed a reduction at the higher but no reduction at the lower dose (< 15 mg/kg vs. ≥ 15 mg/kg and < 20 mg/kg vs. ≥ 20 mg/kg). The majority of patients (81%) were affected by at least 1 adverse event, with decreased renal creatinine clearance being the most frequent. CONCLUSION Higher doses (≥ 15 mg/kg) of deferasirox effectively and safely reduced serum ferritin levels in MDS patients with transfusional iron overload.
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van Spronsen MF, Ossenkoppele GJ, Westers TM, van de Loosdrecht AA. Prognostic relevance of morphological classification models for myelodysplastic syndromes in an era of the revised International Prognostic Scoring System. Eur J Cancer 2016; 56:10-20. [DOI: 10.1016/j.ejca.2015.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/03/2015] [Accepted: 12/04/2015] [Indexed: 01/05/2023]
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Early cytomegalovirus reactivation remains associated with increased transplant-related mortality in the current era: a CIBMTR analysis. Blood 2016; 127:2427-38. [PMID: 26884374 DOI: 10.1182/blood-2015-11-679639] [Citation(s) in RCA: 409] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/04/2016] [Indexed: 01/01/2023] Open
Abstract
Single-center studies have reported an association between early (before day 100) cytomegalovirus (CMV) reactivation and decreased incidence of relapse for acute myeloid leukemia (AML) following allogeneic hematopoietic cell transplantation. To substantiate these preliminary findings, the Center for International Blood and Marrow Transplant Research (CIBMTR) Database was interrogated to analyze the impact of CMV reactivation on hematologic disease relapse in the current era. Data from 9469 patients transplanted with bone marrow or peripheral blood between 2003 and 2010 were analyzed according to 4 disease categories: AML (n = 5310); acute lymphoblastic leukemia (ALL, n = 1883); chronic myeloid leukemia (CML, n = 1079); and myelodysplastic syndrome (MDS, n = 1197). Median time to initial CMV reactivation was 41 days (range, 1-362 days). CMV reactivation had no preventive effect on hematologic disease relapse irrespective of diagnosis. Moreover, CMV reactivation was associated with higher nonrelapse mortality [relative risk [RR] among disease categories ranged from 1.61 to 1.95 and P values from .0002 to <.0001; 95% confidence interval [CI], 1.14-2.61). As a result, CMV reactivation was associated with lower overall survival for AML (RR = 1.27; 95% CI, 1.17-1.38; P <.0001), ALL (RR = 1.46; 95% CI, 1.25-1.71; P <.0001), CML (RR = 1.49; 95% CI, 1.19-1.88; P = .0005), and MDS (RR = 1.31; 95% CI, 1.09-1.57; P = .003). In conclusion, CMV reactivation continues to remain a risk factor for poor posttransplant outcomes and does not seem to confer protection against hematologic disease relapse.
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Abel GA, Buckstein R. Integrating Frailty, Comorbidity, and Quality of Life in the Management of Myelodysplastic Syndromes. Am Soc Clin Oncol Educ Book 2016; 35:e337-e344. [PMID: 27249740 DOI: 10.1200/edbk_158639] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Myelodysplastic syndromes (MDS) are a group of acquired hematopoietic stem cell disorders that manifest with progressive bone marrow failure and have a propensity to transform into leukemia. Although an increase in biologic understanding of MDS has led to improved patient risk stratification and prognostication, advances in treatment have lagged behind. While hematopoietic cell transplantation (HCT) is a potentially curative option for some, most affected patients continue to be treated with supportive care or with drugs that offer temporary palliation such as hematopoietic growth factors, DNA hypomethylating agents, or immunomodulatory therapy. For several groups, such as those with intermediate-risk disease as classified by the Revised International Prognostic Scoring System (IPSS-R) or those with higher-risk disease for whom hypomethylating agents have failed, optimal treatment remains uncertain. Inclusion of patient-related factors such as frailty and comorbid conditions into risk assessment can improve prognostication beyond the disease-associated variables included in systems such as the IPSS-R. This article focuses on approaches to assessing and integrating frailty, comorbidities, and quality of life into the treatment of patients with MDS.
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Affiliation(s)
- Gregory A Abel
- From the Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Department of Medical Oncology/Hematology, Odette Cancer and Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Rena Buckstein
- From the Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Department of Medical Oncology/Hematology, Odette Cancer and Sunnybrook Health Sciences Center, Toronto, ON, Canada
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25
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Della Porta MG, Tuechler H, Malcovati L, Schanz J, Sanz G, Garcia-Manero G, Solé F, Bennett JM, Bowen D, Fenaux P, Dreyfus F, Kantarjian H, Kuendgen A, Levis A, Cermak J, Fonatsch C, Le Beau MM, Slovak ML, Krieger O, Luebbert M, Maciejewski J, Magalhaes SMM, Miyazaki Y, Pfeilstöcker M, Sekeres MA, Sperr WR, Stauder R, Tauro S, Valent P, Vallespi T, van de Loosdrecht AA, Germing U, Haase D, Greenberg PL, Cazzola M. 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; 29:1502-13. [PMID: 25721895 DOI: 10.1038/leu.2015.55] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 02/10/2015] [Accepted: 02/16/2015] [Indexed: 02/03/2023]
Abstract
A risk-adapted treatment strategy is mandatory for myelodysplastic syndromes (MDS). We refined the World Health Organization (WHO)-classification-based Prognostic Scoring System (WPSS) by determining the impact of the newer clinical and cytogenetic features, and we compared its prognostic power to that of the revised International Prognostic Scoring System (IPSS-R). A population of 5326 untreated MDS was considered. We analyzed single WPSS parameters and confirmed that the WHO classification and severe anemia provide important prognostic information in MDS. A strong correlation was found between the WPSS including the new cytogenetic risk stratification and WPSS adopting original criteria. We then compared WPSS with the IPSS-R prognostic system. A highly significant correlation was found between the WPSS and IPSS-R risk classifications. Discrepancies did occur among lower-risk patients in whom the number of dysplastic hematopoietic lineages as assessed by morphology did not reflect the severity of peripheral blood cytopenias and/or increased marrow blast count. Moreover, severe anemia has higher prognostic weight in the WPSS versus IPSS-R model. Overall, both systems well represent the prognostic risk of MDS patients defined by WHO morphologic criteria. This study provides relevant in formation for the implementation of risk-adapted strategies in MDS.
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Affiliation(s)
- M G Della Porta
- 1] Department of Hematology Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy [2] Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - H Tuechler
- Hanusch Hospital, Boltzmann Institute for Leukemia Research, Vienna, Austria
| | - L Malcovati
- 1] Department of Hematology Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy [2] Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - J Schanz
- Georg August Universität, Göttingen, Germany
| | - G Sanz
- Hospital Universitario La Fe, Valencia, Spain
| | - G Garcia-Manero
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - F Solé
- Institut de Recerca contra la Leucèmia Josep Carreras, Barcelona, Spain
| | - J M Bennett
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - D Bowen
- St James's University Hospital, Leeds, UK
| | - P Fenaux
- Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris (AP-HP)/University Paris XIII, Bobigny, France
| | - F Dreyfus
- Hôpital Cochin, AP-HP University of Paris V, Paris, France
| | - H Kantarjian
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - A Kuendgen
- Heinrich-Heine University Hospital, Düsseldorf, Germany
| | - A Levis
- Fondazione Italiana Sindromi Mielodisplastiche c/o SS Antonio e Biagio Hospital, Alessandria, Italy
| | - J Cermak
- Institute of Hematology and Blood Transfusion, Praha, Czech Republic
| | - C Fonatsch
- Medical University of Vienna, Vienna, Austria
| | - M M Le Beau
- University of Chicago Comprehensive Cancer Research Center, Chicago, IL, USA
| | - M L Slovak
- Quest Diagnostics Nichols Institute, Chantilly, VA, USA
| | - O Krieger
- Elisabethinen Hospital, Linz, Austria
| | - M Luebbert
- University of Freiburg Medical Center, Freiburg, Germany
| | | | | | - Y Miyazaki
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - M Pfeilstöcker
- Hanusch Hospital and L. Boltzmann Cluster Oncology, Vienna, Austria
| | | | - W R Sperr
- Medical University of Vienna, Vienna, Austria
| | - R Stauder
- Hanusch Hospital and L. Boltzmann Cluster Oncology, Vienna, Austria
| | - S Tauro
- University of Dundee, Dundee, Scotland, UK
| | - P Valent
- Medical University of Vienna, Vienna, Austria
| | - T Vallespi
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - U Germing
- Heinrich-Heine University Hospital, Düsseldorf, Germany
| | - D Haase
- Georg August Universität, Göttingen, Germany
| | - P L Greenberg
- Division of Hematology, Stanford University Cancer Center, Stanford, CA, USA
| | - M Cazzola
- 1] Department of Hematology Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy [2] Department of Molecular Medicine, University of Pavia, Pavia, Italy
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26
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de Swart L, Smith A, Johnston TW, Haase D, Droste J, Fenaux P, Symeonidis A, Sanz G, Hellström-Lindberg E, Cermák J, Germing U, Stauder R, Georgescu O, MacKenzie M, Malcovati L, Holm MS, Almeida AM, Mądry K, Slama B, Guerci-Bresler A, Sanhes L, Beyne-Rauzy O, Luño E, Bowen D, de Witte T. Validation of the revised international prognostic scoring system (IPSS-R) in patients with lower-risk myelodysplastic syndromes: a report from the prospective European LeukaemiaNet MDS (EUMDS) registry. Br J Haematol 2015; 170:372-83. [PMID: 25907546 DOI: 10.1111/bjh.13450] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/01/2015] [Indexed: 01/22/2023]
Abstract
Baseline characteristics, disease-management and outcome of 1000 lower-risk myelodysplastic syndrome (MDS) patients within the European LeukaemiaNet MDS (EUMDS) Registry are described in conjunction with the validation of the revised International Prognostic Scoring System (IPSS-R). The EUMDS registry confirmed established prognostic factors, such as age, gender and World Health Organization 2001 classification. Low quality of life (EQ-5D visual analogue scale score) was significantly associated with reduced survival. A high co-morbidity index predicted poor outcome in univariate analyses. The IPSS-R identified a large group of 247 patients with Low (43%) and Very low (23%) risk score within the IPSS intermediate-1 patients. The IPSS-R also identified 32 High or Very high risk patients within the IPSS intermediate-1 patients. IPSS-R was superior to the IPSS for predicting both disease progression and survival. Seventy percent of patients received MDS-specific treatment or supportive care, including red blood cell transfusions (51%), haematopoietic growth factors (58%) and iron chelation therapy (8%), within 2 years of diagnosis; while 30% of the patients only required active monitoring. The IPSS-R proved its utility as a more refined risk stratification tool for the identification of patients with a very good or poor prognosis and in this lower-risk MDS population.
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Affiliation(s)
- Louise de Swart
- Department of Haematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Alex Smith
- Epidemiology and Cancer Statistics Group, University of York, York, UK
| | - Thomas W Johnston
- Epidemiology and Cancer Statistics Group, University of York, York, UK
| | - Detlef Haase
- Department of Haematology and Oncology, Georg-August-University of Göttingen, Göttingen, Germany
| | - Jackie Droste
- Department of Haematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Pierre Fenaux
- Service d'Hématologie, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris (AP-HP) and Université Paris 7, Paris, France
| | - Argiris Symeonidis
- Department of Medicine, Divison of Haematology, University of Patras Medical School, Patras, Greece
| | - Guillermo Sanz
- Department of Haematology, Hospital Universitario La Fe, Valencia, Spain
| | - Eva Hellström-Lindberg
- Department of Medicine, Division of Haematology, Karolinska Institutet, Stockholm, Sweden
| | - Jaroslav Cermák
- Department of Clinical Haematology, Institute of Haematology & Blood Transfusion, Praha, Czech Republic
| | - Ulrich Germing
- Department Of Haematology, Oncology and Clinical Immunology, Universitätsklinik Düsseldorf, Düsseldorf, Germany
| | - Reinhard Stauder
- Department of Internal Medicine V (Haematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Otilia Georgescu
- Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Marius MacKenzie
- Department of Haematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Luca Malcovati
- Department of Haematology Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Mette S Holm
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio M Almeida
- Serviço d'Hematologia - Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
| | - Krzysztof Mądry
- Department of Haematology, Oncology and Internal Medicine, Warszawa Medical University, Warszawa, Poland
| | - Borhane Slama
- Service d'Hématologie, Centre Hospitalier d'Avignon, Avignon, France
| | - Agnes Guerci-Bresler
- Service d'Hématologie, Centre Hospitalier Universtaire Brabois Vandoeuvre, Nancy, France
| | - Laurence Sanhes
- Service d'Hématologie, Centre Hospitalier de Perpignan, Perpignan, France
| | - Odile Beyne-Rauzy
- Service d'Hématologie, Centre Hospitalier Universitaire de Purpan, Toulouse, France
| | - Elisa Luño
- Servicio d'Hematología, Servicio de Salud del Principado de Asturias, Oviedo, Spain
| | - David Bowen
- St. James's Institute of Oncology, Leeds Teaching Hospitals, Leeds, UK
| | - Theo de Witte
- Department of Tumor Immunology - Nijmegen, Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands
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