ASH 2010 meeting report—Top 10 clinically‐oriented abstracts in myelodysplastic syndromes (MDS)

Abstract

The December 2010 American Society of Hematology (ASH) annual meeting in Orlando, Florida included more than 150 abstracts in the myelodysplastic syndromes (MDS) category. Thirty-six MDS-focused abstracts were presented in 6 oral sessions, and 120 additional abstracts were presented in 3 poster sessions. Although the 2010 ASH annual meeting included relatively little new MDS clinical trial data, with only one large randomized trial presented (the Intergroup E1905 study), it was an exciting conference from the standpoint of molecular discoveries in myeloid neoplasms, as various investigative groups presented results offering novel insights into MDS pathobiology, generated via high-throughput genomic sequencing and other innovative laboratory techniques. Here I summarize and discuss 10 MDS-related abstracts of special interest, which contain information that informs clinical practice. All 10 of these abstracts are published in full in the November 19, 2010 issue of Blood (volume 116, issue 21) and are identified here by their abstract number and title. Diagnosis and Prognosis No. 1Discrepancy in diagnosis of myelodysplastic syndrome (MDS) between referral and tertiary care centers: experience at MD Anderson cancer center (MDACC) (Abstract # 1870). Abstract summaryThe MD Anderson cancer center (MDACC) leukemia group reviewed data from 915 patients who presented to their institution in Houston, Texas between 2005 and 2009 carrying an outside diagnosis of myelodysplastic syndrome (MDS). Among these 915 patients, there was discordance in diagnosis between the referring practice and the referral center in 150 patients (16%). Sixty of the 150 patients had been diagnosed prior to MDACC referral with forms of MDS without excess marrow blasts [i.e., refractory anemia (RA), refractory anemia with ring sideroblasts (RARS), and refractory cytopenias with multilineage dysplasia (RCMD)]; 46 of these 60 were reassessed at MDACC as having refractory anemia with excess blasts (RAEB), and 6 were rediagnosed as RAEB in transformation (RAEB-t; these patients would be classified as having acute myeloid leukemia (AML) by World Health Organization (WHO) diagnostic criteria [1]). Fifteen patients diagnosed with RAEB on the outside were assessed as having lower-risk MDS at MDACC (i.e., with less than 5% blasts), while 40 patients diagnosed with RAEB on the outside were rediagnosed with RAEB-t. A handful of other patients labeled as MDS underwent diagnostic revision to one of the myeloproliferative neoplasms (MPN), MDS/MPN overlap syndromes, AML, or a benign disorder or indeterminate condition. Causes of diagnostic discrepancy included inadequate initial diagnostic material, differences in sample preparation and staining, over-reliance on flow cytometric assessment of blast proportion, and interpretive differences. While the changes in diagnosis did not have a significant global impact in terms of median survival or clinical outcome, new diagnoses did alter treatment recommendations, clinical trial eligibility, and prognosis for individual...