title: Assessment of the international prognostic scoring system for determining chemotherapeutic indications in myelodysplastic syndrome: Japanese retrospective multicenter study.
abstract: To standardize a rational therapeutic strategy of chemotherapy using the International Prognostic Scoring System (IPSS), we retrospectively analyzed 292 high-risk myelodysplastic syndrome (MDS) patients in 20 hospitals in Japan. Results of multivariate analysis of the data on patients who received all types of chemotherapy indicated that poor cytogenetics as shown by the IPSS was the only significant risk factor (P = .047). We then focused on the IPSS composition of each patient. The intermediate 2 (Int-2) category consisted of a heterogeneous group. We attempted to subdivide the category into Int-2A and Int-2B. Patients with good or intermediate cytogenetics had > or = 5% bone marrow (BM) blasts (Int-2A), and most of the other patients had poor cytogenetics and < or = 10% BM blasts (Int-2B). In the Int-2B category, overall survival for patients who received chemotherapy was significantly worse than for those who did not receive chemotherapy (P = .005). Most patients in the High category who had the diagnosis of MDS according to the World Health Organization classification had poor overall survival with or without chemotherapy. We propose the Int-2B and High categories may be considered possible high risk, whereas all patients in the Int-2A category and patients with more than 5% BM blasts in the Int-1 category may be categorized as being at possible intermediate risk. Our proposition may be useful for developing a chemotherapeutic strategy for patients with MDS in Japan.
authors.affiliation: First Department of Internal Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, Japan. yito@tokyo-med.ac.jp
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Ito
authors.forename: Kazuma
authors.initials: K
authors.lastname: Ohyashiki
authors.forename: Hisamaru
authors.initials: H
authors.lastname: Hirai
authors.forename: Seishi
authors.initials: S
authors.lastname: Ogawa
authors.forename: Kinuko
authors.initials: K
authors.lastname: Mitani
authors.forename: Tomomitsu
authors.initials: T
authors.lastname: Hotta
authors.forename: Masami
authors.initials: M
authors.lastname: Bessho
authors.forename: Tomoki
authors.initials: T
authors.lastname: Naoe
authors.forename: Hideaki
authors.initials: H
authors.lastname: Mizoguchi
authors.forename: Takashi
authors.initials: T
authors.lastname: Uchiyama
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Omine
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D012107:Research Design; D012189:Retrospective Studies; D016019:Survival Analysis