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Nagarjun BR, Kalaharaghini R, Sawhney J, Trivedi PJ, Dhandapani K, Parikh B. Should We Look beyond Revised International Prognostic Scoring System: A Retrospective Observational Study of Progression of Myelodysplastic Syndrome to Acute Leukemia. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1736175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Myelodysplastic syndrome (MDS) is a clonal stem cell disorder and heterogeneous condition resulting in peripheral cytopenias with marrow dysplasia due to ineffective hematopoiesis. The revised International Prognostic Scoring System (IPSS-R) predicts the risk of progression to acute leukemia (AL). Indian data on MDS and its progression to AL are limited. Additionally, the cytogenetic findings are dictated by patients' racial background. Study intended to analyze the cytogenetic profile of the patients with MDS.
Objectives This study aimed to (1) evaluate the clinicohematologic and morphologic spectrum of newly diagnosed MDS cases, (2) evaluate the cytogenetic profile of these cases, and (3) study the cases progressed to AL.
Materials and Methods MDS cases diagnosed and followed-up during a 5-year study period, from January 2015 to December 2019, were included in the study and the study was conducted at regional cancer center in Western India. De novo diagnosed MDS cases with complete workup were considered and MDS due to secondary causes were excluded. Baseline clinical, hematologic findings were tabulated along with cytogenetics and risk stratified as per IPSS-R, and their progression was studied.
Results A total of 63 cases of de novo MDS were diagnosed over a period of 5 years with 45 cases on follow-up and 15 cases (33.3%) progressed to AL. Maximum number of cases belonged to MDS-excess blast (EB) category accounting to 48 cases (76.1%). Apparently normal karyotyping was the commonest cytogenetic finding in 33 MDS cases (61.2%) and in 8 cases that progressed to AL (53.4%).
Conclusion MDS cases diagnosed at relatively early age were at higher risk of progression to AL. Majority of the cases that progressed to AL were risk stratified in high and very high risk groups and 10 cases which progressed to AL belonged to good category, interestingly apparent normal karyotyping was the commonest cytogenetic finding in more than 50% of the cases progressed to AL. Molecular mutations could only explain this progression and studies integrating molecular mutations with present IPSS-R scoring system should be conducted, as it could translate into better risk stratification and help in early identification and better management of cases at risk in progression to AL.
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Affiliation(s)
| | | | - Jyoti Sawhney
- Department of OncoPathology, The Gujarat Cancer & Research Institute, Ahmedabad, Gujarat, India
| | - Pina J. Trivedi
- Department of OncoPathology, The Gujarat Cancer & Research Institute, Ahmedabad, Gujarat, India
| | - Karthik Dhandapani
- Department of OncoPathology, The Gujarat Cancer & Research Institute, Ahmedabad, Gujarat, India
| | - Biren Parikh
- Department of OncoPathology, The Gujarat Cancer & Research Institute, Ahmedabad, Gujarat, India
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Feng X, Chen X, Nie S, Chang Y, Meng F, Zhou J, Mao C, Li T, Yan X, Huang J, Liu S, Gao Y, Xiao S. Decitabine: An effective and safe treatment for myelodysplastic syndrome and acute myeloid leukemia. J Cancer Res Ther 2020; 15:1471-1476. [PMID: 31939424 DOI: 10.4103/0973-1482.204849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective Decitabine is reported to be valuable in treating multiple malignant blood diseases. However, the application of decitabine in myelodysplastic syndromes (MDSs) and acute myeloid leukemia (AML) has not been fully examined. Thus, our study aimed to investigate the clinical efficacy and safety of decitabine in treating such patients. Materials and Methods Clinical data of MDS or AML patients treated with decitabine were retrospectively analyzed. All the patients were regularly followed up, and the risk factors affecting clinical efficacy were also detected. Results A total of 36 patients (MDS, n = 27; AML, n = 9) were included in the study. The response rate of MDS patients was 55%, and there were three cases (15%) of complete remission (CR), three cases (15%) of marrow CR, and five cases (15%) of hematologic improvement. It was about three cycles to achieve the best efficiencies. Gender, age, percentage of blasts in bone marrow, International Prognostic Scoring System risk group, and cytogenetic factors were not associated with response rate. The median overall survival of MDS patients was 8 (1-44) months. Agranulocytosis (P = 0.037) and severe anemia (P = 0.044) were the independent factors for prognosis. The complete response rate of AML was 33.3%. From the investigation, infection was the most common complication in our cohort, especially lung infection with the incidence of 27.8%. Conclusions Our data demonstrated that decitabine was effective and relatively safe in treating MDS and AML. Patients with agranulocytosis and severe anemia were prone to have poor survival, which should be monitored in clinical practice.
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Affiliation(s)
- Xianqi Feng
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiangyun Chen
- Department of Hematology, Shandong Jining No. 1 People's Hospital, Jining, China
| | - Shumin Nie
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yanyan Chang
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Fanjun Meng
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jingjing Zhou
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chunxia Mao
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tianlan Li
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xueshen Yan
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Junxia Huang
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shanshan Liu
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yan Gao
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shuxin Xiao
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Udayakumar AM, Fawaz N, Pathare A, Asraf S, Al-Huneini M, Al-Farsi K, Al-Kindi S, Al-Khabouri M. First Cytogenetic Profile of Omani Patients with de novo Myelodysplastic Syndromes: Comparison with data from Asia, Africa, Europe and North and South America. Sultan Qaboos Univ Med J 2017; 17:e286-e292. [PMID: 29062550 DOI: 10.18295/squmj.2017.17.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/01/2016] [Accepted: 04/06/2017] [Indexed: 11/16/2022] Open
Abstract
Clonal cytogenetic abnormalities have been reported among 30-80% of patients with myelodysplastic syndromes (MDS); however, 20-70% of patients with MDS show a normal karyotype that may nevertheless harbour a cryptic genetic alteration. Earlier reports have suggested that the distribution of specific chromosomal aberrations varies among Western and Asian countries, with geographical and ethnic differences in the frequency of specific chromosomal aberrations. This article compared the cytogenetic data of 36 adult Omani patients with MDS to previously reported data from other populations. Differences were noted between the percentages of clonal aberrations and the median age of Omani subjects at presentation in comparison to individuals of different ethnicities and from various geographical locations. To the best of the authors' knowledge, this is the first report to describe the cytogenetic data of patients with MDS from Oman.
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Affiliation(s)
- Achandira M Udayakumar
- Departments of Genetics, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman.,Department of Malignancy Cytogenetics & Molecular Pathology, Hammersmith Hospital, Imperial College Healthcare National Health Service Trust, London, UK
| | - Nagla Fawaz
- Departments of Genetics Haematology, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Anil Pathare
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Shakila Asraf
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Khalil Al-Farsi
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Salam Al-Kindi
- Departments of Genetics Haematology, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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Chaubey R, Sazawal S, Mahapatra M, Chhikara S, Saxena R. Does Indian Myelodysplastic Syndrome Have a Biology Different from That in the West ? Asian Pac J Cancer Prev 2016; 17:2341-2. [PMID: 27221942 DOI: 10.7314/apjcp.2016.17.4.2341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
abstract.
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Affiliation(s)
- Rekha Chaubey
- Department of Hematology, All India Institute of Medical Sciences, New Delhi E-mail : drrekhacgupta@ gmail.com
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Yue QF, Chen L, She XM, Hu B, Hu Y, Zou P, Liu XY. Clinical Prognostic Factors in 86 Chinese Patients with Primary Myelodysplastic Syndromes and Trisomy 8: A Single Institution Experience. Yonsei Med J 2016; 57:358-64. [PMID: 26847287 PMCID: PMC4740527 DOI: 10.3349/ymj.2016.57.2.358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 12/01/2014] [Accepted: 01/08/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The objective was to determine the characteristics and prognostic factors of 86 Chinese patients with trisomy 8 aberrations and compare the prognostic value of International Prognostic System (IPSS) and Revised IPSS (IPSS-R) in this cohort. MATERIALS AND METHODS A total of 86 cases diagnosed with primary myelodysplastic syndromes (MDS) with isolated tr8 or with tr8 and other additional cytogenetic aberrations diagnosed and treated at the Union Hospital, Tongji Medical College of Huazhong University of Science and Technology between July 2002 and March 2013 were reviewed. RESULTS The median survival of the entire group was 23.0 months, and acute myeloid leukemia (AML) developed in 43% (37/86) patients within the follow up time. The univariate analysis revealed that overall survival (OS) was correlated with age, thrombocytopenia, absolute neutrophil count, marrow blasts, cytogenetic status and red blood cell transfusion at diagnosis, and the multivariate analysis revealed that age, marrow blasts, cytogenetic status and transfusion dependence were independent parameters for the OS. The cytogenetic complexity and marrow blasts had the strongest impact on the AML transformation by multivariate analysis. Comparing the two prognostic systems, both two systems could successfully discriminate risk groups for survival. IPSS-R was more refined than IPSS for predicting OS, but had no advantage in predicting the risk of AML development. CONCLUSION This study confirmed the influence of clinical factors on the prognosis of 86 Chinese MDS patients with trisomy 8. In addition, IPSS-R can further refine prognostic discrimination in the IPSS risk categories.
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Affiliation(s)
- Qing Fang Yue
- Department of Medical Oncology, ShaanXi Provincial People's Hospital, Xi'an, Shaanxi, P.R. China
| | - Lei Chen
- Department of Hematology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Xiao Mei She
- Department of Hematology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Bin Hu
- Department of Hematology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Yu Hu
- Department of Hematology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Ping Zou
- Department of Hematology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Xin Yue Liu
- Department of Hematology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China.
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Kim YJ, Jang JH, Kwak JY, Lee JH, Kim HJ. Use of azacitidine for myelodysplastic syndromes: controversial issues and practical recommendations. Blood Res 2013; 48:87-98. [PMID: 23826577 PMCID: PMC3698413 DOI: 10.5045/br.2013.48.2.87] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/24/2013] [Accepted: 05/30/2013] [Indexed: 01/10/2023] Open
Abstract
Azacitidine is recommended for patients with higher-risk myelodysplastic syndromes (MDS) who are not eligible for intensive therapy or for patients with lower-risk MDS who have thrombocytopenia or neutropenia or have anemia that is unresponsive to other therapies. However, standard treatment with azacitidine has not been optimized and many issues about the use of azacitidine remain unresolved. The use of azacitidine is expanding rapidly, but limited comparative clinical trial data are available to (i) define the optimal use of azacitidine in patients with higher-risk MDS or around the time of allogeneic hematopoietic stem cell transplantation, (ii) identify those patients with lower-risk MDS who may benefit from treatment, and (iii) guide physicians on alternative therapies after treatment failure. Increasing evidence suggests that the clinical features, prognostic factors, and cytogenetic profiles of patients with MDS in Asia differ significantly from those of patients in Western countries, so the aim of this review is to summarize the evidence and provide practical recommendations on the use of azacitidine in patients with MDS in the Republic of Korea. Evidence considered in this review is based on published clinical data and on the clinical experience of an expert panel from the acute myeloid leukemia/MDS Working Party of the Korean Society of Hematology.
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Affiliation(s)
- Yoo-Jin Kim
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Magalhaes SMM, Heredia FF, Fernandes LCM, Almeida PJP, Sousa JC, Souza GF, Pinheiro RF. Beyond race-related disparities: is myelodysplastic syndrome the same everywhere? Leuk Lymphoma 2013; 54:1564-6. [DOI: 10.3109/10428194.2012.749404] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | | | | | | | - Geane F. Souza
- Postgraduation Program in Clinical Medicine, Federal University of Ceará, Brazil
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8
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Mutetwa B, Fryzek J, Du Y, Yong M, Sekeres MA, Taioli E. Baseline characteristics and predictors of outcome in patients with myelodysplastic syndromes living in Western Pennsylvania. Leuk Lymphoma 2011; 52:265-72. [DOI: 10.3109/10428194.2010.540726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kim SH, Lee JH, Choi J, Kwon KA, Lee S, Oh SY, Kwon HC, Han JY, Kim HJ. Improvement of the WHO classification-based prognostic scoring system (WPSS) by including age for Korean patients with the myelodysplastic syndrome. Leuk Res 2010; 34:1589-95. [PMID: 20633929 DOI: 10.1016/j.leukres.2010.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Revised: 02/28/2010] [Accepted: 03/01/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to improve the predictive power of the WHO classification-based prognostic scoring system (WPSS) by including age in patients with the myelodysplastic syndrome (MDS). PATIENTS AND METHODS 136 Korean patients with de novo MDS between 1995 and 2008 were evaluated retrospectively. All patients were reclassified according to WHO criteria. 114 patients were included in the final analysis. An individualized age-adapted scoring system was developed to improve the accuracy of prognosis of the WPSS. RESULTS The WPSS was significantly associated with the prediction of survival and the leukemia-free survival. While the risk of a patient with the WPSS was best represented by the values 0 (very low), +1 (low), +2 (intermediate), +3 (high), and +4 (very high), these values were found to vary between -1.0 and 4.2 in the same patients when age was included as a factor. The WPSS may vary according to age, <55 or ≥55 years. The estimated difference in median survival was more prominent in the lower risk groups of the WPSS than in the higher-risk groups. CONCLUSION In addition to the WPSS, age was found to significantly influence the prognosis of patients with MDS and provided a more individualized prognosis for the patients with MDS.
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Affiliation(s)
- Sung-Hyun Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Seo-gu, Busan, South Korea
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Kobayashi H, Matsuyama T, Ueda M, Suzuki T, Ozaki K, Mori M, Nagai T, Muroi K, Ozawa K. Predictive factors of response and survival following chemotherapy treatment in acute myeloid leukemia progression from myelodysplastic syndrome. Intern Med 2009; 48:1629-33. [PMID: 19755765 DOI: 10.2169/internalmedicine.48.2362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The progression of myelodysplastic syndrome to acute myeloid leukemia (MDS/AML) is generally incurable and its prognosis is extremely poor. It is important to determine the predictive factors of response and survival in diseases treated with chemotherapy. METHODS Twenty-nine patients who had been diagnosed of MDS/AML and had undergone chemotherapy between April 2001 and March 2008 were retrospectively analyzed. RESULTS Of the 29 patients, 21 patients had an abnormal karyotype. Among them, 13 had complex type abnormalities and/or monosomy 7. Twenty-four patients were administered a low-dose AraC containing regimen and 5 received an AML-like regimen as the initial chemotherapy. The responses were CR4/PR2/NR23. The response rate (RR) in the patients with a normal karyotype was significantly better than in those with an abnormal karyotype (62.5% vs. 4.8%, p=0.003). Univariate analyses showed that the hemoglobin level and cytogenetic abnormalities were factors that contributed to the overall survival. CONCLUSION In MDS/AML, patients with a normal karyotype tended to have a better response to chemotherapy. The hemoglobin level and cytogenetic abnormalities were significant factors affecting the overall survival.
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Affiliation(s)
- Hiroyuki Kobayashi
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
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Park MJ, Kim HJ, Kim SH, Kim DH, Kim SJ, Jang JH, Kim K, Kim WS, Jung CW. Is International Prognostic Scoring System (IPSS) still standard in predicting prognosis in patients with myelodysplastic syndrome? External validation of the WHO Classification-Based Prognostic Scoring System (WPSS) and comparison with IPSS. Eur J Haematol 2008; 81:364-73. [PMID: 18637029 DOI: 10.1111/j.1600-0609.2008.01124.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study was undertaken to evaluate the prognostic value of the WHO Classification-Based Prognostic Scoring System (WPSS) and to compare it with that of the International Prognostic Scoring System (IPSS). PATIENTS AND METHODS 149 patients de novo diagnosed as having myelodysplastic syndrome between December 1994 and February 2007, were evaluated retrospectively. RESULTS WPSS presented an excellent method for risk-stratifying patients into five subgroups, with different risks of death and leukaemic evolution. On univariate analysis, three components of WPSS - cytogenetic risk, WHO category and transfusion dependency - had good correlations with overall survival (OS) and time to leukaemic evolution (TTL). However, one component of IPSS - number of peripheral cytopenias - did not correlate with OS or TTL. WPSS could distinguish the truly low-risk patients (very low) who had an excellent long-term survival with rare leukaemic evolution, while IPSS could not. These patients should be managed with clinical observation and delayed treatment strategies. Furthermore, on multivariate analysis for OS, WPSS was found to be an independent prognostic factor for survival along with age [P = 0.04; hazard ratio (HR) = 1.71; 95% confidence interval (CI) 1.02-2.85] and lactate dehydrogenase (LDH) (P = 0.002; HR = 2.47; 95% CI 1.41-4.31). On the other hand, the prognostic significance of IPSS was not confirmed. CONCLUSION These results suggest that the WPSS might be a more powerful predictor of prognosis than IPSS and that independent validation of several other, larger data sets should be necessary.
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Affiliation(s)
- Min Jae Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lee JW. Iron chelation therapy in the myelodysplastic syndromes and aplastic anemia: a review of experience in South Korea. Int J Hematol 2008; 88:16-23. [PMID: 18604581 PMCID: PMC2516545 DOI: 10.1007/s12185-008-0117-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 06/02/2008] [Indexed: 01/19/2023]
Abstract
Emerging clinical data indicate that transfusion-dependent patients with bone marrow-failure syndromes (BMFS) are at risk of the consequences of iron overload, including progressive damage to hepatic, endocrine, and cardiac organs. Despite the availability of deferoxamine (DFO) in Korea since 1998, data from patients with myelodysplastic syndromes, aplastic anemia, and other BMFS show significant iron overload and damage to the heart and liver. The recent introduction of deferasirox, a once-daily, oral iron chelator, may improve the availability of iron chelation therapy to iron-overloaded patients, and improve compliance in patients who may otherwise find adherence to the DFO regimen difficult.
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Affiliation(s)
- Jong Wook Lee
- Division of Hematology, Department of Internal Medicine, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Haferlach T, Bacher U, Kern W, Schnittger S, Gassmann W, Haferlach C. A comprehensive approach to the diagnosis of MDS after triage by morphology towards cytogenetics and other techniques. Cancer Treat Rev 2007. [DOI: 10.1016/j.ctrv.2007.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Dakshinamurthy AG, Novitzky N, Bharadwaj R, Prakhya BM. Cytogenetic analysis of 52 Indian patients with de novo myelodysplastic syndromes?a comparative analysis of results with reports from Asia. Ann Hematol 2005; 84:298-303. [PMID: 15742188 DOI: 10.1007/s00277-004-0997-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2004] [Accepted: 12/13/2004] [Indexed: 10/25/2022]
Abstract
Most published data on myelodysplastic syndromes (MDS) are derived from Western countries, which report MDS as a disease of the elderly. However, it was observed that Asian MDS patients were younger than subjects in Western reports. With this in mind, the study was conducted prospectively on 52 Indian patients to define chromosomal abnormalities and to understand ethno-geographical differences, if any, underlying the pathogenesis of MDS among this Asian population. Cytogenetic analysis was performed using GTG banding and karyotyped according to the International System for Human Cytogenetic Nomenclature (ISCN). The incidence of MDS was predominant in the age group of 41-60 years (44.23%), with a median age at diagnosis of 55 years. The disease was more frequent in males (33 patients, 63.46%) than females (19 patients, 36.53%). Of 48 patients successfully karyotyped, 17 had normal karyotype (35.4%) and 31 patients (64.5%) had a chromosomal abnormality. The most frequent chromosome abnormalities were del 5q/-5 in 13 patients (42%), -7/7q- in 10 patients (32.2%), +8 and del 20q- in 6 cases each (19.3%) and i(17)(q10) in 1 patient (3.2%). In addition to these non-random chromosomal abnormalities, some rare abnormalities were also encountered. A higher rate of transformation to acute myeloid leukaemia (AML) was observed in the Chinese population compared to other Asian countries. The incidence of chromosomal abnormalities varied considerably across the different Asian populations. The overall frequency of chromosomal abnormalities in our study was comparable to most Western reports. Further prospective studies are warranted to elucidate precisely the ethnic differences in the pathogenesis of MDS in the Indian population.
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Affiliation(s)
- Amirtha Ganesh Dakshinamurthy
- Department of Haematology, Groote Schuur Hospital and the University of Cape Town Leukemia Center, Observatory, Cape Town 7925, South Africa.
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Oosterveld M, Wittebol SH, Lemmens WAJG, Kiemeney BALM, Catik A, Muus P, Schattenberg AVMB, de Witte TJM. The impact of intensive antileukaemic treatment strategies on prognosis of myelodysplastic syndrome patients aged less than 61 years according to International Prognostic Scoring System risk groups. Br J Haematol 2003; 123:81-9. [PMID: 14510946 DOI: 10.1046/j.1365-2141.2003.04544.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present study applied the International Prognostic Scoring System (IPSS) to 306 consecutive myelodysplastic syndrome (MDS) patients diagnosed between August 1977 and September 2000 at the University Medical Centre Nijmegen. The aim was to investigate whether the IPSS could be used as a prognostic tool in MDS patients aged less than 61 years who were treated with acute myeloid leukaemia (AML)-like chemotherapy with or without transplantation, and whether the scoring system discriminated between the subgroups of patients who benefit from intensive treatment strategies. The patients were retrospectively assigned to the IPSS risk categories and compared with the IPSS workshop patients. Eighty-three of 159 patients aged < 61 years, classified as intermediate 1, intermediate 2 and high risk according to the IPSS, received intensive treatment consisting of chemotherapy only (n = 30), chemotherapy followed by either autologous stem cell transplantation (n = 7) or allogeneic stem cell transplantation (n = 46). After intensive treatment, the median survival was 2.6 years for the intermediate 1 risk group (n = 33), 3.4 years for the intermediate 2 risk group (n = 27) and 0.9 years for the high-risk group (n = 23). We conclude that the IPSS is an improved scoring system for patients receiving supportive care. Nevertheless, the scoring system does not seem to be the best method for predicting outcome after intensive antileukaemic treatment. In particular, intermediate 2 risk patients may benefit from intensive treatment.
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Affiliation(s)
- Margriet Oosterveld
- Department of Haematology, University Medical Centre Nijmegen, Nijmegen, The Netherlands.
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Valent P, Wimazal F, Schwarzinger I, Sperr WR, Geissler K. Pathogenesis, classification, and treatment of myelodysplastic syndromes (MDS). Wien Klin Wochenschr 2003; 115:515-36. [PMID: 13677270 DOI: 10.1007/bf03041035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Myelodysplastic syndromes (MDS) comprise a heterogeneous group of clonal myeloid disorders characterized by morphologic dysplasia in one or more cell lineages. Dysplasia in MDS is associated with insufficient production of blood cells and consecutive cytopenia(s). The natural course and prognosis of MDS vary among patients and depend on genetic defects that occur during clonal evolution. In a significant group of patients (roughly 30%) progression to secondary leukemia is observed. These patients appear to have a grave prognosis. The treatment of patients with MDS has to be adjusted to the individual situation and age in each case. In many patients, control of blast cell production by palliative cytoreduction, continuous support with red blood cells, as well as other supportive measures, seem appropriate. In other patients, however, curative therapy (chemotherapy, stem cell transplantation) should be considered. The final decision to offer curative therapy must be based on many different factors including age and the overall situation of the patient. Recently established scoring systems aimed at predicting survival and evolution of leukemia in MDS may be helpful in this regard.
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Affiliation(s)
- Peter Valent
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, University of Vienna, Vienna, Austria.
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Lee JH, Lee JH, Shin YR, Lee JS, Kim WK, Chi HS, Park CJ, Seo EJ, Lee KH. Application of different prognostic scoring systems and comparison of the FAB and WHO classifications in Korean patients with myelodysplastic syndrome. Leukemia 2003; 17:305-13. [PMID: 12592327 DOI: 10.1038/sj.leu.2402798] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2002] [Accepted: 09/25/2002] [Indexed: 11/08/2022]
Abstract
We retrospectively studied 227 patients with MDS (1) to identify the prognostic factors of survival and acute leukemia evolution in Korean patients with MDS, (2) to apply different prognostic scoring systems to the same group of patients, and (3) to compare the FAB with the WHO classification. Six scoring systems were applied to the patients, and the FAB and WHO classifications were compared. The patients' median age was 57 years. The median survival time was 21 months, and age, dysgranulopoiesis and the IPSS cytogenetic groups were independent prognostic factors for survival. Acute leukemia occurred in 34 patients, and the cumulative incidence was 27.1% at 3 years. Marrow blast percentage was the only independent prognostic factor for acute leukemia evolution. Most scoring systems successfully discriminated risk groups for survival and acute leukemia evolution, but patient distribution into risk groups varied according to the scoring systems. Refractory cytopenia with multilineage dysplasia and RAEB II seemed to have different prognoses from RA or RARS and RAEB I, respectively. In summary, our MDS patients had different disease natures from those of Western countries regarding clinical features, prognostic factors and cytogenetic profiles. Although the WHO classification seems to improve the FAB classification, further studies are warranted to validate the utility of the WHO classification before it is accepted for routine clinical use. Our study has the limitations of retrospective analysis, and our results should be verified in future prospective studies.
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Affiliation(s)
- J-H Lee
- Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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