Identifying Low-Risk MDS Patients With Poor Survival Prospects

A new scoring system for a form of leukemia known as myelodysplastic syndrome (MDS) identifies patients who appear to have low-risk disease but actually have poor prospects of survival.

Physicians tend to adopt a watch and wait approach to low-risk MDS patients, which can miss low-risk/poor prognosis patients. Myelodysplastic syndromes are a group of conditions that cause insufficient production of blood cells, which is often lethal. About 10 % of patients have their MDS transform into acute myelogenous leukemia.

Dr. Guillermo Garcia-Manero, M.D., associate professor in the University of Texas M. D. Anderson Cancer Center (Houston, TX, USA) and colleagues examined a number of potential molecular and demographic markers to develop a prognostic scoring system for this group by applying them to 856 patients treated at M. D. Anderson between 1976 and 2005. All were rated low or intermediate risk by the International Prognostic Scoring System (IPSS), the mainstay model.

They found that a combination of older age, low platelet counts, anemia, a higher percentage of cancerous cells, or blasts, in the bone marrow and poor-risk cytogenetics (aberrant chromosomes) divided the 856 patients into three clearly defined groups: 182 patients who had few of these characteristics (category 1) had a median survival of 80.3 months; 408 patients who fell into category 2, an intermediate score, had a median survival of 26.6 months; and 265 patients with the highest score who had a median survival of 14.2 months. When IPSS was applied to the same patients, it failed to segregate patients with low or intermediate risk into the new test's risk categories.

In the past three years, therapy for MDS has improved significantly, with approval of three new drugs: lenalidomide, a thalidomide derivative indicated for some patients, and two demethylating agents that turn on genes by removing chemical off switches that block gene expression.


Related Links:
University of Texas M. D. Anderson Cancer Center