Cross‐validation of prognostic scores in myelodysplastic syndromes on 386 patients from a single institution confirms importance of cytogenetics

Abstract

Summary. In myelodysplastic syndromes (MDS) different prognostic risk analysis systems based on clinical and morphological data are used for predicting survival. Data on diagnostic and prognostic relevance of karyotype aberrations have prompted the development of scores including cytogenetics. The aim of this study was to assess and compare the explanatory power of different scoring systems and to assess the additional explanatory power of cytogenetics by evaluating the clinical and laboratory data of MDS patients from a single institution. Data of 386 MDS patients was available, with cytogenetic analysis at time of diagnosis in 256. Clinical/morphological scores: Bournemouth, modi®ed Bournemouth and Du È sseldorf; and scores including cytogenetics: Lausanne±Bournemouth, Lille and the International Prognostic Scoring System (IPSS), were calculated and their predictive power was compared for both overall survival and preleukaemic duration. Each of the scores had signi®cant correlation on both endpoints. Calculating the prognostic value of different cytogenetic aberrations we found that differentiating between evidence for no aberration, single aberrations excluding chromosomes 7 and 8, aberrations on chromosomes 5, 7 or 8 and complex aberrations was important. These data were incorporated in a`prognostic index cytogenetics' (pi score). Cytogenetic scores signi®cantly improved the prognostic value of the best clinical/morphological score in regard to both overall survival and preleukaemic duration. In conclusion, our data further stress the importance of cytogenetics for predicting prognosis in MDS.

Incidence and prognostic significance of karyotype abnormalities in de novo primary myelodysplastic syndromes: a study on 331 patients from a single institution

“…The prognostic relevance of complex karyotypes has been stressed by various reports 3,8,13,14,23 and is confirmed by our data. In the present series RAEB and RAEB-t patients with this cytogenetic pattern presented a 1-year survival probability of 0.15% (95% CI ¼ 0.03-0.34) vs 0.77% (95% CI ¼ 0.66-0.85) (HR ¼ 6.6 (95% CI ¼ 3.5-12.4) and P ¼ 0.001) for those with other abnormalities.…”

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][18][19][20][21][22][23][24][25][26] Chromosome defects were more common in RAEB and RAEB-t than in RARS and RA. Deletions or gains of entire chromosomes had an incidence of 60.4% and translocations of only 1.8%.…”

“…Numerous reports have demonstrated that MDS karyotype abnormalities significantly affect OS and the risk of MDS/AML progression, [6][7][8][9][10][11][12][13][14][15][18][19][20][21][22][23][24][25][26] even in patients undergoing intensive chemotherapies. 27,28 Therefore, in 1997 the IPSS 15 grouped MDS patients (either untreated or submitted to low-dose chemotherapy or growth factors only) into three prognostically different cytogenetic categories and included the chromosome pattern in a new scoring system which has been validated by various reports.…”

“…27,28 Therefore, in 1997 the IPSS 15 grouped MDS patients (either untreated or submitted to low-dose chemotherapy or growth factors only) into three prognostically different cytogenetic categories and included the chromosome pattern in a new scoring system which has been validated by various reports. 23,24,29,30 One of the aims of the present study was to check whether IPSS scores and IPSS cytogenetic categories significantly influenced OS and HRs for MDS/AML progression in a series of 331 MDS patients from a single Institution. In order to achieve these goals, we analyzed a patient population similar to that included in the IPSS study; otherwise the two studies could not be compared.…”

Is FISH a relevant prognostic tool in myelodysplastic syndromes with a normal chromosome pattern on conventional cytogenetics? A study on 57 patients

“…[4][5][6][7][8][9][10][11][12][13][14][15][16] In 1997, the international prognostic scoring system (IPSS) has further emphasized that karyotype is one of the most important prognostic indicators in MDS and can be used along with bone marrow blast cell percentage and number/degree of peripheral cytopenia to subdivide patients into four subgroups having distinct clinical outcomes. 17,18 However, conventional cytogenetics (CCs) reveals a normal karyotype in about 40-60% of patients.…”