title: Predicting survival of patients with hypocellular myelodysplastic syndrome: development of a disease-specific prognostic score system.
abstract: BACKGROUND
  Although most patients with myelodysplastic syndrome (MDS) exhibit bone marrow hypercellularity, a subset of them present with a hypocellular bone marrow. Specific factors associated with poor prognosis have not been investigated in patients with hypocellular MDS.
  
  
  METHODS
  The authors studied a cohort of 253 patients with hypocellular MDS diagnosed at The University of Texas MD Anderson Cancer Center between 1993 and 2007 and a cohort of 1725 patients with hyper-/normocellular MDS diagnosed during the same time period.
  
  
  RESULTS
  Patients with hypocellular MDS presented more frequently with thrombocytopenia (P < .019), neutropenia (P < .001), low serum β-2 microglobulin (P < .001), increased transfusion dependency (P < .001), and intermediate-2/high-risk disease (57% vs 42%, P = .02) compared with patients with hyper-/normocellular MDS. However, no difference in overall survival was observed between the 2 groups (P = .28). Multivariate analysis identified poor performance status (Eastern Cooperative Oncology Group ≥2), low hemoglobin (<10 g/dL), unfavorable cytogenetics (-7/7q or complex), increased bone marrow blasts (≥5%), and high serum lactate dehydrogenase (>600 IU/L) as adverse independent factors for survival.
  
  
  CONCLUSIONS
  A new prognostic model based on these factors was built that segregated patients into 3 distinct risk categories independent of International Prognostic Scoring System (IPSS) score. This model is independent from the IPSS, further refines IPSS-based prognostication, and may be used to develop of risk-adapted therapeutic approaches for patients with hypocellular MDS.
authors.affiliation: Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Wei-Gang
authors.initials: WG
authors.lastname: Tong
authors.forename: Alfonso
authors.initials: A
authors.lastname: Quintás-Cardama
authors.forename: Tapan
authors.initials: T
authors.lastname: Kadia
authors.forename: Gautam
authors.initials: G
authors.lastname: Borthakur
authors.forename: Elias
authors.initials: E
authors.lastname: Jabbour
authors.forename: Farhad
authors.initials: F
authors.lastname: Ravandi
authors.forename: Stefan
authors.initials: S
authors.lastname: Faderl
authors.forename: William
authors.initials: W
authors.lastname: Wierda
authors.forename: Sherry
authors.initials: S
authors.lastname: Pierce
authors.forename: Jianqin
authors.initials: J
authors.lastname: Shan
authors.forename: Carlos
authors.initials: C
authors.lastname: Bueso-Ramos
authors.forename: Hagop
authors.initials: H
authors.lastname: Kantarjian
authors.forename: Guillermo
authors.initials: G
authors.lastname: Garcia-Manero
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001853:Bone Marrow; D001855:Bone Marrow Diseases / Q000097:blood / Q000150:complications / Q000401:mortality*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D015470:Leukemia, Myeloid, Acute; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000097:blood / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D009503:Neutropenia / Q000150:complications; D011379:Prognosis; D012189:Retrospective Studies; D013921:Thrombocytopenia; D055815:Young Adult
chemical_list: D006454:Hemoglobins; D007770:L-Lactate Dehydrogenase