IPSS-R in 555 Taiwanese patients with primary MDS: Integration of monosomal karyotype can better risk-stratify the patients.
The revised International Prognostic Scoring System (IPSS-R) was recently developed to better assess the clinical outcome of adult patients with myelodysplastic syndrome (MDS). In this study, we aimed to investigate the prognostic impact of this new risk model on 555 MDS patients in Taiwan. Generally, the IPSS-R could discriminate MDS patients regarding risk of leukemia evolution and overall survival in our cohort and it further refined prognostic stratification in all IPSS risk categories. However, we could not find the inter-group difference between IPSS-R very low and low risk subgroups in both leukemia-free survival (LFS) and overall survival (OS). IPSS-R couldn't distinguish the prognosis between very good and good and between good and intermediate risk cytogenetic categories in OS, and between very good and good and between intermediate and poor cytogenetic-risk categories in LFS, either. On the other hand, incorporation of monosomal karyotype (MK) into IPSS-R could further stratify MDS patients with higher-risk IPSS-R (intermediate, high and very high risk) into four groups, rather than three groups, with different OS (P < 0.001). Intriguingly, patients receiving allogeneic hematopoietic stem cell transplantation had longer survival than those without in the IPSS-R high and very high, but not other risk groups. Similarly, patients treated with hypomethylating agents had better survival than those not in the IPSS-R very high risk group. In conclusion, IPSS-R can risk-stratify MDS patients in Taiwan but with some limitations, especially in very low risk category, and MK has additional prognostic value in discriminating MDS patients with higher-risk IPSS-R.
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Division of Hematology-Oncology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Taiwan.
Yi-Tsung
YT
Yang
Hsin-An
HA
Hou
Chieh-Yu
CY
Liu
Chien-Chin
CC
Lin
Wen-Chien
WC
Chou
Fen-Yu
FY
Lee
Ming-Chih
MC
Liu
Chia-Wen
CW
Liu
Jih-Luh
JL
Tang
Ming
M
Yao
Chi-Cheng
CC
Li
Yuan-Yeh
YY
Kuo
Shang-Yi
SY
Huang
Bor-Sheng
BS
Ko
Chien-Yuan
CY
Chen
Szu-Chun
SC
Hsu
Chien-Ting
CT
Lin
Shang-Ju
SJ
Wu
Woei
W
Tsay
Yao-Chang
YC
Chen
Hwei-Fang
HF
Tien
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D059785:Karyotype; D007621:Karyotyping; D015470:Leukemia, Myeloid, Acute / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009006:Monosomy; D009190:Myelodysplastic Syndromes / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D012306:Risk; D013624:Taiwan; D016896:Treatment Outcome; D055815:Young Adult
D000964:Antimetabolites, Antineoplastic