Refinement of the international prognostic scoring system (IPSS) by including LDH as an additional prognostic variable to improve risk assessment in patients with primary myelodysplastic syndromes (MDS)

Abstract

The international prognostic scoring system (IPSS) is considered the gold standard for risk assessment in primary myelodysplastic syndromes (MDS). This score includes several prognostic factors except serum lactate dehydrogenase (LDH). We evaluated the prognostic power of LDH as an additional variable in IPSS-based risk assessment. For this purpose, a total of 892 patients with primary MDS registered by the Austrian-German cooperative MDS study group was analyzed retrospectively. Multivariate analysis confirmed the value of established parameters such as medullary blasts, karyotype and peripheral cell counts and showed that elevated LDH was associated with decreased overall survival (Po0.00005) and increased risk of AML development (Po0.00005), independent of the system used to classify MDS (FAB or WHO). Moreover, elevated LDH was found to be a significant predictor of poor survival within each IPSS risk group and within each FAB group except RAEB-T. To exploit these results for refined prognostication, each IPSS risk group was split into two separate categories (A ¼ normal LDH vs B ¼ elevated LDH). Using this LDH-assisted approach, it was possible to identify MDS patients with unfavorable prognosis within the low and intermediate IPSS risk groups. We propose that the IPSS þ LDH score should improve clinical decision-making and facilitate proper risk stratification in clinical trials.

Analyzing transformation of myelodysplastic syndrome to secondary acute myeloid leukemia using a large patient database

“…Improvement in the IPSS scoring method has been suggested by Germing et al, who proposed adding LDH as a prognostic variable in addition to the IPSS group [38], and Garcia-Manero et al [39], who proposed refinement of criteria for classifying lower-risk groups. Here, we propose that patients with MDS stratification may be improved using additional recommended risk factors, such as those described earlier.…”

Marrow fibrosis predicts early fatal marrow failure in patients with myelodysplastic syndromes

“…time of patients with MF. This was also true with respect to the IPSS and its variables, the LDH value 40 as well as the evidence of another relevant histopathologic variable, the ALIP. 22 In multivariate survival analysis, MF appears to provide significant independent prognostic information.…”

International MDS risk analysis workshop (IMRAW)/IPSS reanalyzed: Impact of cytopenias on clinical outcomes in myelodysplastic syndromes

“…However, further refinement is needed for predicting the prognosis of individual patients with MDS, particularly for those in the intermediate-risk groups. More recently, a number of new variables have been proposed that could potentially refine the current IPSS, including lactic dehydrogenase [8][9][10][11], immunophenotyping [12][13][14], further subgrouping of cytogenetic abnormalities [15,16], number of red blood cell (RBC) transfusions [17,18], and depth of neutropenia [19] and thrombocytopenia [20]. Although the number of cytopenias is included as a variable within the IPSS, the depth of cytopenias has not been studied as an independent prognosticator of overall survival (OS) and time to acute myeloid leukemia (AML) evolution in patients with MDS.…”