title: Report on outcomes of hypomethylating therapy for analyzing prognostic value of Revised International Prognostic Scoring System for patients with lower-risk myelodysplastic syndromes.
abstract: The outcomes for patients with lower-risk myelodysplastic syndromes (LR-MDS) by the International Prognostic Scoring System (IPSS) vary widely. For more precise prognostication, this study evaluates the prognostic value of revised IPSS with the response to hypomethylating therapy (HMT). Using the Korean MDS Working Party database, treatment outcomes for 236 patients with HMT were retrospectively evaluated. The patients were then reclassified into very low/low (VL/L), intermediate (INT), and high (H) risk groups according to IPSS-R. According to the HMT response, the 3-year overall survival (OS) did not differ between the response group (37.9 ± 9.1 %) and the stable group (52.9 ± 6.6 %, p = 0. 782). When reclassifying according to IPSS-R, 42 patients (20.8 %) were reclassified into the H risk group. Most of them did not have benefit from continued HMT and progressed to secondary failure. The median OS was 59.0 months (range, 40.0-77.9 months) for the VL/L risk group, 31 months (range, 22.7-439.3 months) for the INT risk group, and 20.0 months (range, 15.9-24.1 months) for the H risk group (p < 0.001). In the multivariate analysis, the following factors were associated with survival: age ≥ 65 (HR = 1.515, p = 0.023), ECOG ≥ 2 (HR = 2.968, p < 0.001), H risk group according to IPSS-R (HR = 3.054, p < 0.001), P/VP cytogenetic risk according to IPSS-R (HR = 4.912, p = 0.003), and transformation to AML (HR = 2.158, p = 0.002). If IPSS-R reclassifies LR-MDS patients as H risk, these patients should be considered for early allo-HCT, regardless of the current benefits from HMT.
authors.affiliation: Department of Hematology/Oncology, Kyungpook National University Hospital, 130 Dongduk-Ro, Jung-Gu, Daegu, 41944, South Korea.
authors.forename: Yoo Jin
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Department of Hematology/Oncology, Kyungpook National University Hospital, 130 Dongduk-Ro, Jung-Gu, Daegu, 41944, South Korea.
authors.forename: Sung Woo
authors.initials: SW
authors.lastname: Park
authors.affiliation: Department of Hematology/Oncology, Kyungpook National University Hospital, 130 Dongduk-Ro, Jung-Gu, Daegu, 41944, South Korea.
authors.forename: In Hee
authors.initials: IH
authors.lastname: Lee
authors.affiliation: Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, Gwangju, South Korea.
authors.forename: Jae Sook
authors.initials: JS
authors.lastname: Ahn
authors.affiliation: Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, Gwangju, South Korea.
authors.forename: Hyeoung Joon
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Hematology/Oncology, Busan National University Hospital, Busan, South Korea.
authors.forename: Joo Seop
authors.initials: JS
authors.lastname: Chung
authors.affiliation: Department of Hematology/Oncology, Busan National University Hospital, Busan, South Korea.
authors.forename: Ho Jin
authors.initials: HJ
authors.lastname: Shin
authors.affiliation: Department of Hematology/Oncology, Inje University Busan Baik Hospital, Busan, South Korea.
authors.forename: Won Sik
authors.initials: WS
authors.lastname: Lee
authors.affiliation: Department of Hematology/Oncology, Inje University Busan Baik Hospital, Busan, South Korea.
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Lee
authors.affiliation: Department of Hematology/Oncology, Inje University Haewoondae Baik Hospital, Busan, South Korea.
authors.forename: Young Don
authors.initials: YD
authors.lastname: Joo
authors.affiliation: Department of Hematology/Oncology, Ulsan University Hospital, Ulsan, South Korea.
authors.forename: Hawk
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Hematology/Oncology, Kosin University Gospel Hospital, Busan, South Korea.
authors.forename: Ho Sup
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Hematology/Oncology, Kosin University Gospel Hospital, Busan, South Korea.
authors.forename: Yang Soo
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Hematology/Oncology, Daegu Catholic University Medical Center, Daegu, South Korea.
authors.forename: Yoon Young
authors.initials: YY
authors.lastname: Cho
authors.affiliation: Department of Hematology/Oncology, Kyungpook National University Hospital, 130 Dongduk-Ro, Jung-Gu, Daegu, 41944, South Korea. jhmoon74@knu.ac.kr.
authors.forename: Joon Ho
authors.initials: JH
authors.lastname: Moon
authors.affiliation: Department of Hematology/Oncology, Kyungpook National University Hospital, 130 Dongduk-Ro, Jung-Gu, Daegu, 41944, South Korea. sksohn@knu.ac.kr.
authors.forename: Sang Kyun
authors.initials: SK
authors.lastname: Sohn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001374:Azacitidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D019175:DNA Methylation / Q000187:drug effects*; D016208:Databases, Factual; D000077209:Decitabine; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000077209:Decitabine; D001374:Azacitidine
keywords: Hypomethylating agent; IPSS; IPSS-R; Lower-risk; Myelodysplastic syndromes