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System Shows Which MDS Patients Fare Worse

CancerWise - March 2008

A new scoring system for a form of leukemia known as myelodysplastic syndrome (MDS) identifies patients who appear to have low-risk disease but actually have poor prospects of survival, researchers say.

Goal of study

"We already know that an undefined group of patients with low-risk MDS will, at some point, experience a sudden worsening of their disease," says Guillermo Garcia-Manero, M.D., an associate professor and chief, Section of Myelodysplastic Syndromes in M. D. Anderson's Department of Leukemia. "Right now, we don't know who these people are, but if we can identify them, we can be more aggressive by starting treatment earlier."

Garcia-Manero, who was lead author on the study that led to the new prognostic scoring system, reported the results in the journal Leukemia in December.

Significance of results

Physicians tend to adopt a watch and wait approach to low-risk MDS patients, which misses low-risk/poor-prognosis patients, Garcia-Manero says.

Background

Myelodysplastic syndromes, which are often lethal, are a group of conditions that cause insufficient production of blood cells. MDS progresses to acute myelogenous leukemia (AML) in 10% of patients.

Research methods

Garcia-Manero and his colleagues developed the new scoring system by examining molecular and demographic markers in 856 patients.

The study involved patients who were:

  • Treated at M. D. Anderson between 1976 and 2005
  • Diagnosed with low- or intermediate-risk MDS

Primary results

Half the patients over the 30-year period died, and 90% of those died of MDS that had not progressed to AML.

Several characteristics determined whether low-risk MDS developed into a more advanced form.

Factors linking low-risk MDS patients with poor prognosis:

  • Older age
  • Low platelet counts
  • Anemia
  • High number of cancer cells in the bone marrow
  • Genetic factors

Using this data, patients were divided into these groups:

Category 1 – Patients with few of the defined characteristics had a median survival of 80.3 months.

Category 2 – Patients with more characteristics had a median survival of 26.6 months.

Category 3 – Patients with the most characteristics had a median survival of 14.2 months.

Additional results

Researchers also used the International Prognostic Scoring System (IPSS), the current standard for determining MDS risk. Unlike the new scoring system, the IPSS did not recognize those low-risk MDS patients who developed the more dangerous form of the disease.

What's next?

Garcia-Manero says the scoring system will be applied in clinical trials at M. D. Anderson immediately.

– Adapted by Dawn Dorsey from an M. D. Anderson news release

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© 2014 The University of Texas MD Anderson Cancer Center