The efficacy of current prognostic models in predicting outcome of patients with myelodysplastic syndromes at the time of hypomethylating agent failure

Hypomethylating agents (HMA) treatment for myelodysplastic syndromes: alternatives in the frontline and relapse settings

“…Clinically, risk factors for worse survival include age, male sex, high-risk cytogenetics, higher blast count, and lack of prior response to azacitidine [17, 61]. Eligible patients may attempt transplant; however, many patients are not candidates due to comorbidities and poor performance status.…”

Validation of a post-hypomethylating agent failure prognostic model in myelodysplastic syndromes patients treated in a randomized controlled phase III trial of rigosertib vs. best supportive care

“…Clinical trials enrolling patients at the time of HMA failure (HMAF) have often used the International Prognostic Scoring System (IPSS) or the Revised IPSS (IPSS-R) as eligibility criterion for trial entry 4 , 5 . We have previously shown that the IPSS, IPSS-R and other commonly used MDS prognostic models (e.g., the World Health Organization classification-based Prognostic Scoring System, and the MD Anderson Prognostic Scoring System) have limited predictive power in the HMAF setting 6 . We therefore developed and validated a new model to predict outcome of patients after HMAF 6 that includes six clinical variables: age; performance status; complex cytogenetics (>4 abnormalities); marrow blast percentage >20%; platelet count; and red cell transfusion dependency 6 .…”

“…We have previously shown that the IPSS, IPSS-R and other commonly used MDS prognostic models (e.g., the World Health Organization classification-based Prognostic Scoring System, and the MD Anderson Prognostic Scoring System) have limited predictive power in the HMAF setting 6 . We therefore developed and validated a new model to predict outcome of patients after HMAF 6 that includes six clinical variables: age; performance status; complex cytogenetics (>4 abnormalities); marrow blast percentage >20%; platelet count; and red cell transfusion dependency 6 . This model separates patients into two risk categories: lower-risk, with a median OS of 11.0 months (95% confidence interval (CI) 8.8–13.6); and higher-risk disease, with median OS of 4.5 months (95% CI 3.9–5.3) 6 .…”

“…We therefore developed and validated a new model to predict outcome of patients after HMAF 6 that includes six clinical variables: age; performance status; complex cytogenetics (>4 abnormalities); marrow blast percentage >20%; platelet count; and red cell transfusion dependency 6 . This model separates patients into two risk categories: lower-risk, with a median OS of 11.0 months (95% confidence interval (CI) 8.8–13.6); and higher-risk disease, with median OS of 4.5 months (95% CI 3.9–5.3) 6 . The model was subsequently validated in an independent cohort of 223 MDS patients derived from the Groupe Francophone des Myélodysplasies database 7 .…”

Predicting outcome of patients with myelodysplastic syndromes after failure of azacitidine: validation of the North American MDS consortium scoring system

“…Defining variables that may influence outcome after HMA failure appears to be an important issue. In a recent publication from the North American MDS consortium, 6 Nazha et al defined a score of 6 variables (including age, ECOG PS, bone marrow blast counts, cytogenetics, platelet counts, and RBC transfusiondependency, see Online supplementary Table S1 for details) which seems to discriminate the outcome of MDS patients with HMA failure more efficiently than the revised IPSS, 7 or other prognostic models. In Nazha et al's model, the patients were classified into a low-risk group (score below 2.5, median OS 11 months) and a high-risk group (score 2.5 and above, median OS 4.5 months).…”