Incorporation of molecular data into the Revised International Prognostic Scoring System in treated patients with myelodysplastic syndromes.
The Revised International Prognostic Scoring System (IPSS-R) was developed for untreated myelodysplastic syndrome (MDS) patients based on clinical data. We created and validated a new model that incorporates mutational data to improve the predictive capacity of the IPSS-R in treated MDS patients. Clinical and mutational data from treated MDS patients diagnosed between January 2000 and January 2012 were used to develop the new prognostic system. A total of 508 patients were divided into training (n=333) and validation (n=175) cohorts. Independent significant prognostic factors for survival included age, IPSS-R, EZH2, SF3B1 and TP53. Weighted coefficients for each factor were used to build the new linear predictive model, which produced four prognostic groups: low, intermediate-1, intermediate-2 and high with a median overall survival of 37.4, 23.2, 19.9 and 12.2 months, respectively, P<0.001. Significant improvement in the C-index of the new model (0.73) was observed compared with the IPSS-R (0.69). The new model predicted outcome both in a separate validation cohort and in another cohort of patients with paired samples at different time points during their disease course. The addition of mutational data to the IPSS-R makes it dynamic and enhances its predictive ability in treated MDS patients regardless of their initial or subsequent therapies.
Leukemia Program, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland, OH, USA.
A
A
Nazha
Leukemia Program, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland, OH, USA.
M
M
Narkhede
Translational Hematology and Oncology Research Department, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA.
T
T
Radivoyevitch
Leukemia Program, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland, OH, USA.
D J
DJ
Seastone
Translational Hematology and Oncology Research Department, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA.
B J
BJ
Patel
Leukemia Program, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland, OH, USA.
A T
AT
Gerds
Leukemia Program, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland, OH, USA.
S
S
Mukherjee
Leukemia Program, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland, OH, USA.
M
M
Kalaycio
Leukemia Program, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland, OH, USA.
A
A
Advani
Translational Hematology and Oncology Research Department, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA.
B
B
Przychodzen
Leukemia Program, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland, OH, USA.
H E
HE
Carraway
Translational Hematology and Oncology Research Department, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA.
J P
JP
Maciejewski
Leukemia Program, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland, OH, USA.
M A
MA
Sekeres
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009154:Mutation; D009190:Myelodysplastic Syndromes / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods* / Q000592:standards; D015996:Survival Rate; D055815:Young Adult