Therapy-related Myelodysplastic Syndromes Deserve Specific Diagnostic Sub-Classification and Risk-Stratification-An Approach to Classification of Patients With t-MDS | Aplastic Anemia & MDS International Foundation

Therapy-related Myelodysplastic Syndromes Deserve Specific Diagnostic Sub-Classification and Risk-Stratification-An Approach to Classification of Patients With t-MDS

Journal Title: 
Leukemia
Primary Author: 
A Kuendgen
Author(s): 
A Kuendgen, M Nomdedeu, H Tuechler, G Garcia-Manero, R S Komrokji, M A Sekeres, M G Della Porta, M Cazzola, A E DeZern, G J Roboz, D P Steensma, A A Van de Loosdrecht, R F Schlenk, J Grau, X Calvo, S Blum, A Pereira, P Valent, D Costa, A Giagounidis, B Xicoy, H Döhner, U Platzbecker, C Pedro, M Lübbert, I Oiartzabal, M Díez-Campelo, M T Cedena, S Machherndl-Spandl, M López-Pavía, C D Baldus, M Martinez-de-Sola, R Stauder, B Merchan, A List, C Ganster, et al
Original Publication Date: 
Monday, June 29, 2020

In the current World Health Organization (WHO)-classification, therapy-related myelodysplastic syndromes (t-MDS) are categorized together with therapy-related acute myeloid leukemia (AML) and t-myelodysplastic/myeloproliferative neoplasms into one subgroup independent of morphologic or prognostic features. Analyzing data of 2087 t-MDS patients from different international MDS groups to evaluate classification and prognostication tools we found that applying the WHO classification for p-MDS successfully predicts time to transformation and survival (both p < 0.001). The results regarding carefully reviewed cytogenetic data, classifications, and prognostic scores confirmed that t-MDS are similarly heterogeneous as p-MDS and therefore deserve the same careful differentiation regarding risk. As reference, these results were compared with 4593 primary MDS (p-MDS) patients represented in the International Working Group for Prognosis in MDS database (IWG-PM). Although a less favorable clinical outcome occurred in each t-MDS subset compared with p-MDS subgroups, FAB and WHO-classification, IPSS-R, and WPSS-R separated t-MDS patients into differing risk groups effectively, indicating that all established risk factors for p-MDS maintained relevance in t-MDS, with cytogenetic features having enhanced predictive power. These data strongly argue to classify t-MDS as a separate entity distinct from other WHO-classified t-myeloid neoplasms, which would enhance treatment decisions and facilitate the inclusion of t-MDS patients into clinical studies.

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