title: Use of newer prognostic indices for patients with myelodysplastic syndromes in the low and intermediate-1 risk categories: a population-based study.
abstract: BACKGROUND
  We aimed to compare the ability of recently developed prognostic indices for myelodysplastic syndromes to identify patients with poor prognoses within the lower-risk (low and intermediate-1) categories defined by the International Prognosis Scoring System (IPSS).
  
  
  METHODS
  We included patients with de-novo myelodysplastic syndromes diagnosed between Nov 29, 1972, and Dec 15, 2011, who had low or intermediate-1 IPSS scores and were in the Spanish Registry of Myelodysplastic Syndromes. We reclassified these patients with the new prognostic indices (revised IPSS [IPSS-R], revised WHO-based Prognostic Scoring System [WPSS-R], Lower Risk Scoring System [LRSS], and the Grupo Español de Síndromes Mielodisplásicos [Spanish Group of Myelodysplastic Syndromes; GESMD]) and calculated the overall survival of the different risk groups within each prognostic index to identify the groups of patients with overall poor prognoses (defined as an expected overall survival <30 months). We calculated overall survival with the Kaplan-Meier method.
  
  
  RESULTS
  We identified 2373 patients. None of the prognostic indices could be used to identify a population with poor prognoses (median overall survival <30 months) for the patients with low IPSS scores (1290 individuals). In the group with intermediate-1 scores (1083 individuals), between 17% and 47% of patients were identified as having poor prognoses with the new prognostic indices. The LRSS had the best model fit with the lowest value in the Akaike information criteria test, whereas the IPSS-R identified the largest proportion of patients with poor prognoses (47%). Patients with intermediate-1 scores who were classified as having poor prognoses by one or more prognostic index (646 [60%] individuals) had worse median overall survival (33·1 months, 95% CI 28·4-37·9) than did patients who were classified as having low risk by all prognostic indices (63·7 months, 49·5-78·0], HR 1·9, 95% CI 1·6-2·3, p<0·0001) INTERPRETATION: Recently proposed prognostic indices for myelodysplastic syndromes can be used to improve identification of patients with poor prognoses in the group of patients with intermediate-1 IPSS scores, who could potentially benefit from a high-risk treatment approach.
  
  
  BACKGROUND
  None.
authors.affiliation: Hematology Department, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain. Electronic address: dvalcarcel.vhebron@me.com.
authors.forename: David
authors.initials: D
authors.lastname: Valcárcel
authors.affiliation: Hematology Department, Hospital Universitario y Politecnico La Fe, Valencia, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Sanz
authors.affiliation: Hematology Department, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Margarita
authors.initials: M
authors.lastname: Ortega
authors.affiliation: Hematology Department, Hospital Clinic, Barcelona, Spain.
authors.forename: Benet
authors.initials: B
authors.lastname: Nomdedeu
authors.affiliation: Hematology Department, Hospital Universitario Central de Asturias. Oviedo, Spain.
authors.forename: Elisa
authors.initials: E
authors.lastname: Luño
authors.affiliation: Hematology Department, University Hospital and IBSAL, Salamanca, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Diez-Campelo
authors.affiliation: Hematology Department, Hospital Universitario Araba, Vitoria, Spain.
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Ardanaz
authors.affiliation: Hematology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Pedro
authors.affiliation: Hematology Department, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Julía
authors.initials: J
authors.lastname: Montoro
authors.affiliation: Hematology Department, Centro de Diagnóstico Biomédico, Hospital General Universitario, Valencia, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Collado
authors.affiliation: Hematology Department, Hospital Doctor Peset, Valencia, Spain.
authors.forename: Rafa
authors.initials: R
authors.lastname: Andreu
authors.affiliation: Hematology Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Marco
authors.affiliation: Hematology Department, Hospital 12 de Octubre, Madrid, Spain.
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Cedena
authors.affiliation: Hematology Department, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: de Paz
authors.affiliation: Hematology and Oncology Department, Hospital Clnd On Universitario, INCLIVA Institute, Valencia, Spain.
authors.forename: Mar
authors.initials: M
authors.lastname: Tormo
authors.affiliation: Hematology Department, Institut Catall datallut Ca-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Auttersi de Barcelona, Leon.
authors.forename: Blanca
authors.initials: B
authors.lastname: Xicoy
authors.affiliation: Clinal Hematology Department, Hospital Universitario de Leon, Leon.
authors.forename: Fernando
authors.initials: F
authors.lastname: Ramos
authors.affiliation: Hematology Department, Hospital Son Llatzer, Majorca, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Bargay
authors.affiliation: Hematology Department. Hospital Universitario de Canarias, Tenerife.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Gonzalez
authors.affiliation: Hematology Department, Hospital de la Santa Creu i Sant Pau, Unviversitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Salut
authors.initials: S
authors.lastname: Brunet
authors.affiliation: Hematology Department, Hospital Puerta del Mar, Cádiz, Spain.
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Muñoz
authors.affiliation: Hematology Department, Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Valle
authors.initials: V
authors.lastname: Gomez
authors.affiliation: Hematology Department, Hospital Carlos Haya, MDepar, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Bailén
authors.affiliation: Reina Sofia University Hospital, Instituto Maimmtuto de Investigaciga Biommtiga de Ctigacigacivers, University of Córdoba, Córdoba, Spain.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Sanchez
authors.affiliation: Hematology Department, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Brayan
authors.initials: B
authors.lastname: Merchán
authors.affiliation: Hematology Department, University Hospital and IBSAL, Salamanca, Spain.
authors.forename: Consuelo
authors.initials: C
authors.lastname: del Cañizo
authors.affiliation: Hematology Department, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Vallespí
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000145:classification / Q000175:diagnosis*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis