title: Bone marrow blasts level predicts prognosis in patients with refractory cytopenia with multilineage dysplasia.
abstract: OBJECTIVE
  Current prognostic models for myelodysplastic syndrome (MDS) do not consider the prognostic value of a bone marrow blast level that is <5%. Exploring the prognostic value of the International Prognostic Scoring System (IPSS) and a marrow blast level that is <5% may lead to better risk-adapted therapeutic strategies.
  
  
  METHODS
  According to the World Health Organization classification, most of our patients (65.5%) fell into the new category 'refractory cytopenia with multilineage dysplasia' (RCMD). We evaluated the prognostic value of the IPSS in 435 adult patients with de novo MDS and in the 285 of them that had RCMD in a Chinese population. We also analyzed the prognostic value of bone marrow blast levels in patients with RCMD and in different IPSS risk groups.
  
  
  RESULTS
  We found a significant difference in survival times between RCMD patients with a marrow blast level of 3.5% or higher vs. those with a blast level of <3.5%, with median survival times of 23.7 and 40.8 months, respectively. In addition, application of a marrow blast level cutoff of 3.5% in patients with RCMD could identify patients with a lower IPSS risk but with a potentially worse prognosis. Multivariate analysis showed marrow blast level (using 3.5% as the cutoff) to be an independent factor that impacted survival times of patients with RCMD. Furthermore, we also found that IPSS had strong prognostic value in Chinese RCMD population.
  
  
  CONCLUSIONS
  In patients with RCMD, a higher percentage of marrow blasts was associated with a worse prognosis.
authors.affiliation: Department of Hematology, Huashan Hospital of Fudan University, Shanghai, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Wang
authors.forename: Xiao-Qin
authors.initials: XQ
authors.lastname: Wang
authors.forename: Xiao-Ping
authors.initials: XP
authors.lastname: Xu
authors.forename: Guo-Wei
authors.initials: GW
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001853:Bone Marrow / Q000473:pathology*; D001856:Bone Marrow Examination; D002452:Cell Count; D019070:Cell Lineage; D002681:China / Q000453:epidemiology; D005260:Female; D006412:Hematopoietic Stem Cells / Q000473:pathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000145:classification / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D015588:Observer Variation; D011379:Prognosis; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D055815:Young Adult