title: Enumerating bone marrow blasts from nonerythroid cellularity improves outcome prediction in myelodysplastic syndromes and permits a better definition of the intermediate risk category of the Revised International Prognostic Scoring System (IPSS-R).
abstract: The Revised International Prognostic Scoring System (IPSS-R) has been recognized as the score with the best outcome prediction capability in MDS, but this brought new concerns about the accurate prognostication of patients classified into the intermediate risk category. The correct enumeration of blasts is essential in prognostication of MDS. Recent data evidenced that considering blasts from nonerythroid cellularity (NECs) improves outcome prediction in the context of IPSS and WHO classification. We assessed the percentage of blasts from total nucleated cells (TNCs) and NECs in 3924 MDS patients from the GESMD, 498 of whom were MDS with erythroid predominance (MDS-E). We assessed if calculating IPSS-R by enumerating blasts from NECs improves prognostication of MDS. Twenty-four percent of patients classified into the intermediate category were reclassified into higher-risk categories and showed shorter overall survival (OS) and time to AML evolution than those who remained into the intermediate one. Likewise, a better distribution of patients was observed, since lower-risk patients showed longer survivals than previously whereas higher-risk ones maintained the outcome expected in this poor prognostic group (median OS < 20 months). Furthermore, our approach was particularly useful for detecting patients at risk of dying with AML. Regarding MDS-E, 51% patients classified into the intermediate category were reclassified into higher-risk ones and showed shorter OS and time to AML. In this subgroup of MDS, IPSS-R was capable of splitting our series in five groups with significant differences in OS only when blasts were assessed from NECs. In conclusion, our easy-applicable approach improves prognostic assessment of MDS patients.
authors.affiliation: Laboratorio Citología Hematológica. Servicio Patología, GRETNHE, IMIM Hospital del Mar Research Institute, Barcelona, Spain.
authors.forename: Xavier
authors.identifier: http://orcid.org/0000-0001-7934-9130
authors.initials: X
authors.lastname: Calvo
authors.affiliation: Laboratorio Citología Hematológica. Servicio Patología, GRETNHE, IMIM Hospital del Mar Research Institute, Barcelona, Spain.
authors.forename: Leonor
authors.initials: L
authors.lastname: Arenillas
authors.affiliation: Servicio Hematología, Hospital Universitario Central Asturias, Oviedo, Spain.
authors.forename: Elisa
authors.initials: E
authors.lastname: Luño
authors.affiliation: Servicio Hematología, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Leonor
authors.initials: L
authors.lastname: Senent
authors.affiliation: Servicio Hematología, ICO-Hospitalet de Llobregat, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Arnan
authors.affiliation: Servicio Hematología, Hospital Universitario de León, León, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Ramos
authors.affiliation: Servicio Hematología, IMIM Hospital del Mar Research Institute, Barcelona, Spain.
authors.forename: Carme
authors.initials: C
authors.lastname: Pedro
authors.affiliation: Servicio Hematología, Hospital Clínico Universitario de Valencia, Valencia, Spain.
authors.forename: Mar
authors.initials: M
authors.lastname: Tormo
authors.affiliation: Servicio Hematología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors.forename: Julia
authors.initials: J
authors.lastname: Montoro
authors.affiliation: Servicio Hematología, Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Díez-Campelo
authors.affiliation: Servicio Hematología, Hospital de la Santa Creu i Sant Pau, Univeristat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: María Laura
authors.initials: ML
authors.lastname: Blanco
authors.affiliation: Servicio Hematología, Hospital Universitario Cruces, Baracaldo, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Arrizabalaga
authors.affiliation: Servicio Hematología, ICO-Badalona, Badalona, Spain.
authors.forename: Blanca
authors.initials: B
authors.lastname: Xicoy
authors.affiliation: Servicio Hematología, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Bonanad
authors.affiliation: Servicio Hematología y Oncología Médica, Hospital Morales Meseguer, IMIB-Arrixaca, Murcia, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Jerez
authors.affiliation: Servicio Hematología, Hospital Clínic, Barcelona, Spain.
authors.forename: Meritxell
authors.identifier: http://orcid.org/0000-0002-2839-3577
authors.initials: M
authors.lastname: Nomdedeu
authors.affiliation: Laboratorio Citología Hematológica. Servicio Patología, GRETNHE, IMIM Hospital del Mar Research Institute, Barcelona, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Ferrer
authors.affiliation: Servicio Hematología, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Guillermo F
authors.initials: GF
authors.lastname: Sanz
authors.affiliation: Laboratorio Citología Hematológica. Servicio Patología, GRETNHE, IMIM Hospital del Mar Research Institute, Barcelona, Spain.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Florensa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D001853:Bone Marrow / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers