Purpose To analyze the incidence and significance of thrombocytopenia in patients with myelodysplastic syndrome (MDS). Patients and Methods A total of 2517 patients with MDS referred to our institution since 1993 were analyzed, with a specific focus on the incidence and associations of thrombocytopenia. Results The median age of the study group was 66 years. The median survival was 13 months. Platelet counts <100 × 109/L were noted in 65%, and platelets counts <30 × 109/L in 26%. Each platelets count drop below the range of 200 × 109/L has shown a larger magnitude change in terms of worsening effect on survival. Therefore, smaller ranges of platelet counts of <200 × 109/L were studied. Platelet cutoffs of 30, 50, and 200 × 109/L thus were identified to have significant associations with differences in survival. Significant thrombocytopenia was associated with poor performance, other cytopenias, adverse karyotype, and advanced MDS phases. Thrombocytopenia was associated with worse prognosis; it also was predicted for worse outcome within each of the International Prognostic Scoring System risk groups. Conclusion Prognosis in MDS is directly associated with the severity of thrombocytopenia.
BACKGROUND: Acute pulmonary failure during remission induction therapy is a serious complication in patients with acute myeloid leukemia (AML). To the authors' knowledge, the course and prognosis of such patients is not well known. METHODS: A total of 1541 patients referred for remission induction chemotherapy of AML or high-risk myelodysplastic syndrome were retrospectively reviewed. RESULTS: A total of 120 (8%) patients developed acute pulmonary failure within 2 weeks of the initiation of chemotherapy; 87 of these patients (73%) died during remission induction, whereas 17 (14%) achieved a complete response. The median survival among the 120 patients with early acute pulmonary failure was 3 weeks. Predictive factors for the development of early acute pulmonary failure by multivariate analysis were: male sex (P ¼ .00038), acute promyelocytic leukemia (P ¼ .00003), poor performance status (P ¼ .001), lung infiltrates at diagnosis (P ¼ .000001), and increased creatinine (P ¼ .000005). Patients who had 0 to 1, 2, 3, or 4 to 5 adverse factors were found to have estimated predictive incidences of acute pulmonary failure of 3%, 13%, 23%, and 34%, respectively. CONCLUSIONS: Preventive approaches at the start of induction therapy in patients at high risk of pulmonary failure may improve the outcome of these patients. Cancer 2010;116: 93-7.
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