Serum ferritin and ECOG performance status predict the response and improve the prognostic value of IPSS or IPSS-R in patients with high-risk myelodysplastic syndromes and oligoblastic acute myeloid leukemia treated with 5-azacytidine: a retrospective analysis of the Hellenic national registry of myelodysplastic and hypoplastic syndromes

Abstract

Background: 5-azacytidine (5-AZA) improves survival of patients with higher-risk myelodysplastic syndromes (MDSs) and oligoblastic acute myeloid leukemia (AML); however, predictive factors for response and outcome have not been consistently studied. Methods: This study of the Hellenic MDS Study Group included 687 consecutive patients with higher-risk MDS and oligoblastic AML treated with 5-AZA. Results: The International Prognostic Scoring System (IPSS) revised version (IPSS-R), Eastern Cooperative Oncology Group Performance Status (ECOG PS) (0 or 1 versus ⩾2) and baseline serum ferritin (SF) levels > 520 ng/ml were shown to independently predict response to 5-AZA. In the survival analysis, the IPSS and IPSS-R risk classification systems along with the ECOG PS and SF levels > 520 ng/ml proved to be independent prognosticators for overall survival (OS), as well as for leukemia-free survival (LFS). Next, we built new multivariate models for OS and LFS, incorporating only ECOG PS and SF levels besides IPSS or IPSS-R risk classification systems. Thereby, the new modified IPSS and IPSS-R risk classification systems (H-PSS, H-PSS-R) could each discriminate a low, an intermediate and a high-risk patient group regarding OS and LFS. The H-PSS and H-PSS-R proved to be better predictors of OS than their previous counterparts as well as the French prognostic score, while the most powerful OS predictor was the new, H-PSS-R system. Conclusions: ECOG PS and SF levels > 520 ng/ml independently predict response to 5-AZA, OS and LFS. Their incorporation in the IPSS and IPSS-R scores enhances these scores’ predictive power in 5-AZA-treated higher-risk MDS and oligoblastic AML patients.

Real-world treatment patterns and clinical outcomes in Korean patients with AML ineligible for first-line intensive chemotherapy: A subanalysis of the CURRENT study, a non-interventional, retrospective chart review

“…Evaluation of PFS according to patient subgroups revealed that patients diagnosed with versus without secondary AML, with an ECOG performance status ≥2 versus 0 or 1, with poor or intermediate versus favorable cytogenetic risk, or with CCI ≥1 versus 0 had shorter median PFS. These results are consistent with previous studies in which poor ECOG performance status and comorbidity index scores were associated with shorter median PFS [23].…”

“…When evaluating OS in patient subgroups, we found that those diagnosed with versus without secondary AML, with an ECOG performance status ≥2 versus 0 or 1, with poor or intermediate versus favorable cytogenetic risk, or with CCI ≥1 versus 0 had a shorter median OS. Similar observations have been reported in previous studies [14, 23-25].…”

Myelodysplastic Syndromes and Myelodysplastic Syndromes/Myeloproliferative Neoplasms: A Real-World Experience From a Developing Country

“…Its incorporation into risk stratification could help identify high-risk patients most likely to benefit from alternative therapeutic approaches. 48 , 49 …”

Real-World Treatment Patterns and Clinical Outcomes in Korean Patients With AML Ineligible for First-Line Intensive Chemotherapy: A Subanalysis of the CURRENT Study, a Non-Interventional, Retrospective Chart Review

“…These results are consistent with previous studies in which poor ECOG performance status and comorbidity index scores were associated with shorter median PFS. 25 …”