title: The WHO classification of MDS does make a difference.
abstract: The purpose of this study was to determine the facility and reliability of the World Health Organization (WHO) classification of myelodysplastic syndromes (MDSs) with several observers reviewing the same diagnostic specimens. We also wanted to determine if the WHO classification provided additional information about predictability of clinical response outcome. To accomplish these goals we reviewed 103 previously diagnosed cases of low-risk MDS. We found 92% interobserver agreement (P <.001). Sixty-four of these patients had been entered into clinical trials using growth factors by the Nordic MDS Study Group. The WHO classification reliably predicted therapeutic response to the combination of granulocyte colony-stimulating factor (G-CSF) and erythropoietin (Epo). The response rate differed significantly between refractory anemia with ringed sideroblasts (RARS) and refractory anemia with multilineage dysplasia and ringed sideroblasts (RCMD/RS) with regard to therapeutic response (75% versus 9%; P =.003). Also, in the group of patients with less than 5% marrow blasts, there was a difference in median survival between patients with unilineage dysplasia (51% surviving at 67 months) and those with multilineage dysplasia (median survival, 28.5 months; P =.03).
authors.affiliation: Division of Hematology, Oncology and Transplantation, University of Minnesota, Mayo Mail Code 480, 420 Delaware St SE, Minneapolis, MN 55455, USA. howex001@umn.edu
authors.forename: Robert B
authors.initials: RB
authors.lastname: Howe
authors.forename: Anna
authors.initials: A
authors.lastname: Porwit-MacDonald
authors.forename: Robert
authors.initials: R
authors.lastname: Wanat
authors.forename: Ramin
authors.initials: R
authors.lastname: Tehranchi
authors.forename: Eva
authors.initials: E
authors.lastname: Hellström-Lindberg
mesh_terms: D002965:Classification / Q000379:methods; D004359:Drug Therapy, Combination; D004921:Erythropoietin / Q000627:therapeutic use; D005500:Follow-Up Studies; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D009190:Myelodysplastic Syndromes / Q000145:classification* / Q000453:epidemiology / Q000401:mortality; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014944:World Health Organization
chemical_list: D004921:Erythropoietin; D016179:Granulocyte Colony-Stimulating Factor