Prognostic Relevance of the Kinetics of Worsening of Cytopenias in Lower-Risk MDS: A Substudy from the European Leukemianet Low Risk MDS (EUMDS) Registry | Aplastic Anemia and MDS International Foundation

Prognostic Relevance of the Kinetics of Worsening of Cytopenias in Lower-Risk MDS: A Substudy from the European Leukemianet Low Risk MDS (EUMDS) Registry

Original Publication Date: 
Tuesday, January 1, 2013

Note: This review is based upon a presentation at the 2012 American Society of Hematology (ASH) Annual Meeting, December 7-10 in Atlanta, Georgia.The full abstract may be reviewed on the ASH Annual Meeting Web site. Search by entering the title in the search box. The abstract number is referenced to access the full report.

Abstract # 700

Raphael Itzykson1, Alex Smith2, Theo M. de Witte3, Jackie Droste4, Reinhard Stauder5, Argyris Symeonidis6, Eva Hellstrom-Lindberg, MD7, Guillermo Sanz8, Jaroslav Cermak, MD, PhD9, Otilia Georgescu10, Mette Skov-Holm11, Ulrich Germing, MD12, Marius MacKenzie4, Odile Beyne-Rauzy, MD, PhD13, Luca Malcovati, MD14, David Bowen, MD15 and Pierre Fenaux, MD, PhD16

Many doctors use the International Prognostic Scoring System (IPSS) to evaluate each patient’s myelodysplastic syndrome (MDS) and select appropriate therapy. But the prognosis of patients with a low or intermediate-1 IPSS score can vary widely. One reason might be that the IPSS and other MDS prognostic systems rely on patient information from only one point in time.

Researchers analyzed data on 530 patients with MDS from the European MDS Registry to find out whether changes in some of their blood test results could be useful for prognostic purposes. All of the patients had a low or intermediate-1 IPSS score, and blood test results were available from at least three visits over at least 12 months. None of the patients had been treated with a hypomethylating agent (such as Vidaza® [azacitidine] or Dacogen® [decitabine]), a granulocyte colony-stimulating factor, hydroxyurea, or Revlimid® (lenalidomide). Patients’ median age was 73 years, and 59% were male.

Key Findings:

  • Patients with slower drops in absolute neutrophil counts (ANC) and platelet counts survived longer than patients with more rapid drops in these blood cell counts.
  • Rates of overall survival did not differ in patients whose hemoglobin counts dropped more quickly or more slowly.
  • The pace of change in ANC, platelet, and hemoglobin counts was not related to patient age, score on the IPSS or other MDS prognostic systems, or abnormal chromosomes.

Conclusions:

  • Faster drops in ANC and, to a lesser extent, platelet counts are associated with shorter survival regardless of the patient’s score on the IPSS, Revised IPSS, or World Health Organization classification-based prognostic scoring system.
  • The rate of changes in hemoglobin counts is not related survival, possibly because patients with low hemoglobin counts are often treated with blood transfusions or erythropoiesis-stimulating agents.
  • In patients with lower-risk MDS, doctors can use the rate of ANC and platelet count declines to predict the course of the disease.
Reviewer Bio: