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Prognostic Factors and Life Expectancy in Myelodysplastic Syndromes Classified According to WHO Criteria: A Basis for Clinical Decision Making
- Source :
- Journal of Clinical Oncology. 23:7594-7603
- Publication Year :
- 2005
- Publisher :
- American Society of Clinical Oncology (ASCO), 2005.
-
Abstract
- Purpose The aim of this study was to evaluate the prognostic value of the WHO proposal, to assess the role of the main prognostic factors in myelodysplastic syndromes (MDSs) classified into WHO subgroups, and to estimate mortality (standardized mortality ratio [SMR]) and life expectancy in these groups as a basis for clinical decision making. Patients and Methods Four hundred sixty-seven patients who were diagnosed as having de novo MDS at the Division of Hematology, University of Pavia (Pavia, Italy), between 1992 and 2002, were evaluated retrospectively for clinical and hematologic features at diagnosis, overall survival (OS), and progression to leukemia (leukemia-free survival). Results Significant differences in survival were noted between patients with refractory anemia (RA), refractory cytopenia with multilineage dysplasia, RA with excess blasts, type 1 (RAEB-1), and RAEB-2. The effect of demographic factors on OS was observed in MDS patients without excess blasts (age, P = .001; sex, P = .006), as in the general population. The mortality of RA patients 70 years or older did not differ significantly from that of the general population (SMR, 1.62; P = .06). Cytogenetics was the only International Prognostic Scoring System variable showing a prognostic value in MDS classified into WHO subgroups. Transfusion-dependent patients had a significantly shorter survival than patients who did not require transfusions (P < .001). Developing a secondary iron overload significantly affected the survival of transfusion-dependent patients (P = .003). Conclusion These data show that the WHO classification of MDSs has a relevant prognostic value. This classification, along with cytogenetics, might be useful in decisions regarding transplantation. MDS with isolated erythroid lineage dysplasia identifies a subset of truly low-risk patients, for whom a conservative approach is advisable.
- Subjects :
- Adult
Male
Cancer Research
medicine.medical_specialty
Pediatrics
Anemia
acute myeloid leukemia
decision making
Life Expectancy
Bone Marrow
Internal medicine
medicine
Humans
Blood Transfusion
Aged
Demography
Retrospective Studies
transfusion
Aged, 80 and over
Myelodysplastic syndrome
anemia
chromosomal aberration
prognosis
risk assessment
Hematology
business.industry
Myelodysplastic syndromes
Middle Aged
medicine.disease
Leukemia
Standardized mortality ratio
Oncology
International Prognostic Scoring System
Karyotyping
Myelodysplastic Syndromes
Life expectancy
Female
Refractory cytopenia with multilineage dysplasia
business
Subjects
Details
- ISSN :
- 15277755 and 0732183X
- Volume :
- 23
- Database :
- OpenAIRE
- Journal :
- Journal of Clinical Oncology
- Accession number :
- edsair.doi.dedup.....17b9db512a514594b4ca3336a545cfcc