Dynamic assessment of RBC‐transfusion dependency improves the prognostic value of the revised‐IPSS in MDS patients

Abstract

RBC-transfusion dependency (RBC-TD) is an independent prognostic factor for poor overall survival (OS) in the WHO classification-based prognostic scoring system (WPSS) for MDS patients. However, WPSS did not include cytopenia, whereas revised International Prognostic Scoring System (IPSS-R) did not include RBC-TD. Thus, neither of these prognostic scoring systems incorporates both cytopenia and RBC-TD. We aimed to test whether RBC-TD adds prognostic value to the IPSS-R. We analyzed MDS patients not treated with disease-modifying therapy, and enrolled in SA-MDS Registry (derivation cohort; n = 295) and Dusseldorf registry (Germany; validation cohort; n = 113) using time-dependent Cox proportional regression and serial landmark analyses. In the derivation cohort, RBC-TD patients had inferior OS compared to RBC transfusion-independent (RBC-TI) patients (P < 0.0001) at 6- (18 vs. 64 months), 12- (24 vs. 71 months), and 24-months (40 vs. 87 months). In a Cox proportional regression analysis, RBC-TD was an independent adverse prognostic marker in addition to age, sex, and IPSS-R variables (P < 0.0001). A prognostic index (PI) was derived using these Cox-proportional regression model variables. In the validation cohort, this PI classified patients into four prognostic groups with significantly different OS (P < 0.001) as in the derivation cohort. In conclusion, multivariate analysis by Cox proportional hazards regression and serial landmark analyses clearly demonstrates that development of RBC-TD at any time during the course of MDS is associated with poor OS, independent of IPSS-R. This study demonstrates that dynamic assessment of RBC-TD provides additional prognostic value to IPSS-R and should be included in treatment decision algorithms for MDS patients.

Comprehensive geriatric assessment predicts azacitidine treatment duration and survival in older patients with myelodysplastic syndromes

“…Repeat bone marrow biopsies were performed as clinically indicated. Red blood celltransfusion dependency (RBC-TD) was defined as requirement of at least one RBC unit every eight weeks over a four-month period [17,18].…”

Red cell alloimmunization is associated with development of autoantibodies and increased red cell transfusion requirements in myelodysplastic syndrome

“…The South Australian MDS Registry has been described previously. 7 Briefly, it is a comprehensive, state-wide database of adult patients with MDS, MDS/myeloproliferative neoplasm overlap syndrome, acute myeloid leukemia (<30% blasts) and therapy-related myeloid neoplasm from six participating hospitals across the public and private sectors ( Online Supplementary Methods ). Institutional ethics committee approval was obtained from all participating institutions and procedures were performed in accordance with the revised Helsinki Declaration.…”

“…RBC transfusion dependency was defined as the requirement of at least one RBC unit every 8 weeks over a 4-month period. 7 , 8 As some patients received RBC transfusions before their MDS diagnosis had been established, we assessed the serial blood counts, clinical profile and RBC transfusion requirements of all patients before and after MDS diagnosis. RBC units transfused before the diagnosis of MDS were considered MDS-related if a patient was transfused to alleviate persistent or progressive anemia due to MDS.…”

“…Up to 90% of patients require RBC transfusions during the course of their disease 6 and 30–45% become dependent on RBC transfusions. 7 , 8 …”

Outpatient transfusions: time to study what matters to patients

“…In myelodysplastic syndrome (MDS), for example, transfusion dependency—variably defined as receiving at least one to two units of blood every 8 weeks for a period of 16 weeks—has been shown to be an independent predictor of mortality, and the dynamic assessment of RBC transfusion dependency improves the prognostic accuracy of the Revised International Prognostic Scoring System in MDS patients . However, the paucity of effective therapies for reversing or mitigating transfusion dependence in myelodysplasia and many myeloid cancers means that patients will require chronic transfusion therapy.…”