title: Prognostic impact of severe thrombocytopenia in low-risk myelodysplastic syndrome.
abstract: BACKGROUND
  Thrombocytopenia is very common in myelodysplastic syndrome (MDS); however, its clinical impact in low-risk patients remains controversial.
  
  
  METHODS
  The authors analyzed the incidence and prognostic significance of thrombocytopenia at diagnosis in 2565 de novo MDS patients included in the Spanish MDS Registry.
  
  
  RESULTS
  Thrombocytopenia (platelet count <100 × 10(9) /L) was identified in 842 patients (32.8%). Severe thrombocytopenia (platelet count <30 × 10(9) /L) was observed in 7.1% of patients and was significantly associated with a higher-risk World Health Organization subtype (P = .026) and intermediate-2/high-risk International Prognostic Scoring System (IPSS) score (P = .046). Severe thrombocytopenia was the most important prognostic factor and had negative effects on the low/intermediate-1 risk group. Median overall survival of patients with a platelet count <30 and ≥ 30 × 10(9) /L was 16 months and 71 months, respectively (hazard ratio, 4.66; 95% confidence interval, 2.74-7.90; P < .0001). The negative effect of severe thrombocytopenia in low/intermediate-1 risk patients was caused by increased risk of bleeding.
  
  
  CONCLUSIONS
  MDS patients with low/intermediate-1 IPSS risk score and severe thrombocytopenia should no longer be regarded as low risk, and must be considered for disease-altering approaches at diagnosis.
authors.affiliation: Salamanca University Hospital, Salamanca, Spain. jrgp@usal.es.
authors.forename: Jose Ramon
authors.initials: JR
authors.lastname: Gonzalez-Porras
authors.forename: Iris
authors.initials: I
authors.lastname: Cordoba
authors.forename: Esperanza
authors.initials: E
authors.lastname: Such
authors.forename: Benet
authors.initials: B
authors.lastname: Nomdedeu
authors.forename: Teresa
authors.initials: T
authors.lastname: Vallespi
authors.forename: Felix
authors.initials: F
authors.lastname: Carbonell
authors.forename: Elisa
authors.initials: E
authors.lastname: Luño
authors.forename: Maite
authors.initials: M
authors.lastname: Ardanaz
authors.forename: Fernando
authors.initials: F
authors.lastname: Ramos
authors.forename: Carme
authors.initials: C
authors.lastname: Pedro
authors.forename: Valle
authors.initials: V
authors.lastname: Gomez
authors.forename: Raquel
authors.initials: R
authors.lastname: de Paz
authors.forename: Mercedes
authors.initials: M
authors.lastname: Sanchez-Barba
authors.forename: Guillermo F
authors.initials: GF
authors.lastname: Sanz
authors.forename: And Consuelo
authors.initials: AC
authors.lastname: Del Cañizo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000097:blood* / Q000150:complications* / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D013921:Thrombocytopenia / Q000150:complications* / Q000453:epidemiology; D055815:Young Adult