title: Therapy-related myelodysplastic syndrome: morphologic subclassification may not be clinically relevant.
abstract: In practice, cases of therapy-related myelodysplastic syndrome (t-MDS) are often classified according to morphologic schemes used for de novo MDS. However, there are few data addressing the appropriateness of such classification. We studied 155 patients with therapy-related acute myeloid leukemia (t-AML)/t-MDS to determine whether subclassification by the World Health Organization (WHO) criteria for de novo MDS provides prognostic information in t-MDS. In addition, we assessed whether cytogenetic stratification by the International Prognostic Scoring System (IPSS) guidelines or karyotypic complexity was prognostically important. We found no differences in median survival times among patients classified into the different WHO subgroup of MDS or according to their bone marrow blast percentage; our results indicate a uniformly poor outcome in t-MDS regardless of morphologic classification. However, significant survival differences correlated with cytogenetic stratification according to IPSS guidelines and/or karyotypic complexity. We found only a borderline difference in median survival of patients with an initial t-MDS diagnosis compared with patients with an initial t-AML diagnosis.
authors.affiliation: Section of Hematopathology, Department of Pathology, University of Chicago, Chicago, IL 60637, USA.
authors.forename: Zeba N
authors.initials: ZN
authors.lastname: Singh
authors.forename: Dezheng
authors.initials: D
authors.lastname: Huo
authors.forename: John
authors.initials: J
authors.lastname: Anastasi
authors.forename: Sonali M
authors.initials: SM
authors.lastname: Smith
authors.forename: Theodore
authors.initials: T
authors.lastname: Karrison
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Le Beau
authors.forename: Richard A
authors.initials: RA
authors.lastname: Larson
authors.forename: James W
authors.initials: JW
authors.lastname: Vardiman
mesh_terms: D000208:Acute Disease; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002869:Chromosome Aberrations / Q000139:chemically induced; D006801:Humans; D007951:Leukemia, Myeloid / Q000209:etiology; D009190:Myelodysplastic Syndromes / Q000139:chemically induced* / Q000145:classification* / Q000473:pathology; D011379:Prognosis; D012306:Risk; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents