title: Validation of the MD Anderson Prognostic Risk Model for patients with myelodysplastic syndrome.
abstract: BACKGROUND
  The proposed MD Anderson Risk Model Score (MDAS) for myelodysplastic syndromes (MDS) refines outcome discrimination compared with the International Prognostic Scoring System (IPSS). We applied the MDAS to Moffitt Cancer Center (MCC) MDS patients to validate its prognostic utility.
  
  
  METHODS
  This was a retrospective analysis of MDS cases, as defined by World Health Organization criteria, from the Moffitt database, with confirmatory chart review.
  
  
  RESULTS
  A total of 775 patients evaluated between January 2001 and December 2009 were included. Patients were reclassified by MDAS as low (20.6%), intermediate-1 (31%), intermediate-2 (21%), high risk (16.1%), and unknown (11.2%). Median overall survival (OS) from diagnosis was 92, 49, 27, and 14 months for low, intermediate-1, intermediate-2, and high-risk MDAS groups, respectively (P < .005). Median OS from referral was 61, 28, 15, and 8 months (P < .005), respectively. Among 484 patients classified by IPSS as low or intermediate-1 risk, 25% were up-staged as intermediate-2 or high risk by MDAS; 4 prognostically distinct subgroups were identified among lower risk IPSS categories with median OS of 93, 53, 31, and 18 months (P < .005). Among 201 intermediate-2 or high-risk IPSS patients, 15.4% were down-staged to intermediate-1 by MDAS, with 3 groups identified by MDAS having median OS of 33, 23, and 14 months. Acute myeloid leukemia transformation rate was highest among high-risk MDAS (50.4%). In Cox regression analysis, higher risk MDAS predicted inferior OS (hazard ratio 1.42; P < .005) independent of IPSS.
  
  
  CONCLUSIONS
  Our data validated MDAS' prognostic value. MDAS is complementary to IPSS and refines prognostic precision.
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. Rami.komrokji@moffitt.org
authors.forename: Rami S
authors.initials: RS
authors.lastname: Komrokji
authors.forename: Maria
authors.initials: M
authors.lastname: Corrales-Yepez
authors.forename: Najla
authors.initials: N
authors.lastname: Al  Ali
authors.forename: Mohammad
authors.initials: M
authors.lastname: Kharfan-Dabaja
authors.forename: Eric
authors.initials: E
authors.lastname: Padron
authors.forename: Teresa
authors.initials: T
authors.lastname: Fields
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lancet
authors.forename: Alan F
authors.initials: AF
authors.lastname: List
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk