title: Impact of the degree of anemia on the outcome of patients with myelodysplastic syndrome and its integration into the WHO classification-based Prognostic Scoring System (WPSS).
abstract: BACKGROUND
  Anemia is an established negative prognostic factor in myelodysplastic syndromes but the relationship between its degree and clinical outcome is poorly defined. We, therefore, studied the relationship between severity of anemia and outcome in myelodysplastic syndrome patients.
  
  
  METHODS
  We studied 840 consecutive patients diagnosed with myelodysplastic syndromes at the Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, and 504 patients seen at the Heinrich-Heine-University Hospital, Düsseldorf, Germany. Hemoglobin levels were monitored longitudinally and analyzed by means of time-dependent Cox's proportional hazards regression models.
  
  
  RESULTS
  Hemoglobin levels lower than 9 g/dL in males (HR 5.56, P=0.018) and 8 g/dL in females (HR=5.35, P=0.026) were independently related to reduced overall survival, higher risk of non-leukemic death and cardiac death (P<0.001). Severe anemia, defined as hemoglobin below these thresholds, was found to be as effective as transfusion-dependency in the prognostic assessment. After integrating this definition of severe anemia into the WHO classification-based Prognostic Scoring System, time-dependent regression and landmark analyses showed that the refined model was able to identify risk groups with different survivals at any time during follow up.
  
  
  CONCLUSIONS
  Accounting for severity of anemia through the WHO classification-based Prognostic Scoring System provides an objective criterion for prognostic assessment and implementation of risk-adapted treatment strategies in myelodysplastic syndrome patients.
authors.affiliation: Department of Hematology Oncology, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. luca.malcovati@unipv.it
authors.forename: Luca
authors.initials: L
authors.lastname: Malcovati
authors.forename: Matteo G
authors.initials: MG
authors.lastname: Della Porta
authors.forename: Corinna
authors.initials: C
authors.lastname: Strupp
authors.forename: Ilaria
authors.initials: I
authors.lastname: Ambaglio
authors.forename: Andrea
authors.initials: A
authors.lastname: Kuendgen
authors.forename: Kathrin
authors.initials: K
authors.lastname: Nachtkamp
authors.forename: Erica
authors.initials: E
authors.lastname: Travaglino
authors.forename: Rosangela
authors.initials: R
authors.lastname: Invernizzi
authors.forename: Cristiana
authors.initials: C
authors.lastname: Pascutto
authors.forename: Mario
authors.initials: M
authors.lastname: Lazzarino
authors.forename: Ulrich
authors.initials: U
authors.lastname: Germing
authors.forename: Mario
authors.initials: M
authors.lastname: Cazzola
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications*; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000401:mortality; D006801:Humans; D019190:Iron Overload / Q000209:etiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000175:diagnosis / Q000401:mortality*; D011379:Prognosis; D065227:Transfusion Reaction; D014944:World Health Organization; D055815:Young Adult