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05-10-2011 | Oncology | Article

Novel scoring model improves prognosis prediction in MDS patients

Abstract

Free abstract

MedWire News: Using the MD Anderson Risk Model Score (MDAS) increases the precision with which the prognosis of patients with myelodysplastic syndrome (MDS) can be made, study results show.

"The most appealing features of the [MDAS] model are its flexibility, applicability to chronic myelomonocytic leukemia (CMML) and therapy-related MDS, its ability to adjust to severity of cytopenias, and the incorporation of patient age and performance status," remark the authors.

They explain that the International Prognostic Scoring System (IPSS), the current standard for determining MDS patient prognosis, has limitations such as a failure to account for cytopenia severity and host-specific factors, including age.

However, these limitations are overcome by use of the MDAS, say Rami Komrokji (H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA) and colleagues in the journal Cancer.

The findings arise from the analysis of 775 MDS patients with a mean age of 66.7 years (74% of the group were older than 60 years). All were initially IPSS-classified as low- (18.8%), intermediate-1- (43.6%), intermediate-2- (20.6%), high- (5.3%), or unknown risk (11.6%) for poor outcome, in keeping with the current management MDAS strategy.

Indeed, treatment for MDS is currently determined by patient-outcome risk group. Low- or intermediate-1-risk patients receive a treatment plan designed to improve cytopenias and hematopoiesis, but intermediate-2- or high-risk patients are treated with the aim of delaying acute myeloid leukemia (AML) transformation, and extending overall survival (OS).

Komrokji and team found that OS after diagnosis fell with increasing poor-outcome risk, with a median OS of 84, 43, 20, and 14 months for low-, intermediate-1-, intermediate-2-, and high-risk groups, respectively.

When the MDAS was used to classify the patients into the same categories as the IPSS, 25.0% of the 484 patients initially classified as low or intermediate-1-risk were reclassified into a higher risk group, and 15.4% were reclassified into a lower risk group.

MDAS also resulted in the reclassification of poor-outcome risk, such that 20.6% of patients were classified as low-, 31.0% as intermediate-1-, 21.0% as intermediate-2-, 16.1% as high-, and 11.2% as having unknown risk.

Cox regression analysis revealed that MDAS increased the accuracy of OS prediction compared with IPSS; a higher MDAS risk predicted inferior OS independently of IPSS. Low-, intermediate-1-, intermediate-2-, and high-risk patients classified by MDAS had respective median OS durations of 93, 53, 31, and 18 months.

Komrokji and co-authors conclude: "The greater prognostic precision of the MDAS and applicability at any point in the disease course should lead to improved management decisions, which could potentially impact an individual's disease outcome."

By Lauretta Ihonor

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