title: Comparison of risk stratification tools in predicting outcomes of patients with higher-risk myelodysplastic syndromes treated with azanucleosides.
abstract: Established prognostic tools in patients with myelodysplastic syndromes (MDS) were largely derived from untreated patient cohorts. Although azanucleosides are standard therapies for higher-risk (HR)-MDS, the relative prognostic performance of existing prognostic tools among patients with HR-MDS receiving azanucleoside therapy is unknown. In the MDS Clinical Research Consortium database, we compared the prognostic utility of the International Prognostic Scoring System (IPSS), revised IPSS (IPSS-R), MD Anderson Prognostic Scoring System (MDAPSS), World Health Organization-based Prognostic Scoring System (WPSS) and the French Prognostic Scoring System (FPSS) among 632 patients who presented with HR-MDS and were treated with azanucleosides as the first-line therapy. Median follow-up from diagnosis was 15.7 months. No prognostic tool predicted the probability of achieving an objective response. Nonetheless, all five tools were associated with overall survival (OS, P=0.025 for the IPSS, P=0.011 for WPSS and P<0.001 for the other three tools). The corrected Akaike Information Criteria, which were used to compare OS with the different prognostic scoring systems as covariates (lower is better) were 4138 (MDAPSS), 4156 (FPSS), 4196 (IPSS-R), 4186 (WPSS) and 4196 (IPSS). Patients in the highest-risk groups of the prognostic tools had a median OS from diagnosis of 11-16 months and should be considered for up-front transplantation or experimental approaches.
authors.affiliation: Department of Internal Medicine, Section of Hematology, Yale Comprehensive Cancer Center, Yale University, New Haven, CT, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Zeidan
authors.affiliation: Leukemia Program, Department of Translational Hematology and Oncology Research, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Sekeres
authors.affiliation: Department of leukemia, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: G
authors.initials: G
authors.lastname: Garcia-Manero
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: D P
authors.initials: DP
authors.lastname: Steensma
authors.affiliation: Leukemia Program, Department of Translational Hematology and Oncology Research, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: K
authors.initials: K
authors.lastname: Zell
authors.affiliation: Leukemia Program, Department of Translational Hematology and Oncology Research, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: J
authors.initials: J
authors.lastname: Barnard
authors.affiliation: Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
authors.forename: N A
authors.initials: NA
authors.lastname: Ali
authors.affiliation: Leukemia Program, Department of Translational Hematology and Oncology Research, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: C
authors.initials: C
authors.lastname: Zimmerman
authors.affiliation: Department of Medicine, Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: G
authors.initials: G
authors.lastname: Roboz
authors.affiliation: Department of Medicine, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA.
authors.forename: A
authors.initials: A
authors.lastname: DeZern
authors.affiliation: Leukemia Program, Department of Translational Hematology and Oncology Research, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: A
authors.initials: A
authors.lastname: Nazha
authors.affiliation: Department of leukemia, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: E
authors.initials: E
authors.lastname: Jabbour
authors.affiliation: Department of leukemia, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: H
authors.initials: H
authors.lastname: Kantarjian
authors.affiliation: Department of Internal Medicine, Section of Hematology, Yale Comprehensive Cancer Center, Yale University, New Haven, CT, USA.
authors.forename: S D
authors.initials: SD
authors.lastname: Gore
authors.affiliation: Leukemia Program, Department of Translational Hematology and Oncology Research, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Maciejewski
authors.affiliation: Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
authors.forename: A
authors.initials: A
authors.lastname: List
authors.affiliation: Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
authors.forename: R
authors.initials: R
authors.lastname: Komrokji
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001374:Azacitidine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D016208:Databases, Factual; D000077209:Decitabine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D012107:Research Design; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents; D000077209:Decitabine; D001374:Azacitidine