International scoring system for evaluating prognosis in myelodysplastic syndromes

Peter Greenberg, Christopher Cox, Michelle M. LeBeau, Pierre Fenaux, Pierre Morel, Guillermo Sanz, Miguel Sanz, Teresa Vallespi, Terry Hamblin, David Oscier, Kazuma Ohyashiki, Keisuke Toyama, Carlo Aul, Ghulam Mufti, John Bennett

Research output: Contribution to journalArticle

Abstract

Despite multiple disparate prognostic risk analysis systems for evaluating clinical outcome for patients with myelodysplastic syndrome (MDS), imprecision persists with such analyses. To attempt to improve on these systems, an International MDS Risk Analysis Workshop combined cytogenetic, morphological, and clinical data from seven large previously reported risk- based studies that had generated prognostic systems. A global analysis was performed on these patients, and critical prognostic variables were re- evaluated to generate a consensus prognostic system, particularly using a more refined bone marrow (SM) cytogenetic classification. Univariate analysis indicated that the major variables having an impact on disease outcome for evolution to acute myeloid leukemia were cytogenetic abnormalities, percentage of BM myeloblasts, and number of cytopenias; for survival, in addition to the above, variables also included age and gender. Cytogenetic subgroups of outcome were as follows: 'good' outcomes were normal, - Y alone, del(5q) alone, del(20q) alone; 'poor' outcomes were complex (ie, ≤3 abnormalities) or chromosome 7 anomalies; and 'intermediate' outcomes were other abnormalities. Multivariate analysis combined these cytogenetic subgroups with percentage of BM blasts and number of cytopenias to generate a prognostic model. Weighting these variables by their statistical power separated patients into distinctive subgroups of risk for 25% of patients to undergo evolution to acute myeloid leukemia, with: low (31% of patients), 9.4 years; intermediate-1 (INT-1; 39%), 3.3 years; INT-2 (22%), 1.1 years; and high (8%), 0.2 year. These features also separated patients into similar distinctive risk groups for median survival: low, 5.7 years; INT-1, 3.5 years; INT-2, 1.2 years; and high, 0.4 year. Stratification for age further improved analysis of survival. Compared with prior risk-based classifications, this International Prognostic Scoring System provides an improved method for evaluating prognosis in MDS. This classification system should prove useful for more precise design and analysis of therapeutic trials in this disease.

Original languageEnglish (US)
Pages (from-to)2079-2088
Number of pages10
JournalBlood
Volume89
Issue number6
StatePublished - Mar 15 1997
Externally publishedYes

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Myelodysplastic Syndromes
Cytogenetics
Risk analysis
Acute Myeloid Leukemia
Chromosomes
Granulocyte Precursor Cells
Bone
Chromosomes, Human, Pair 7
Survival
Survival Analysis
Chromosome Aberrations
iodonitrotetrazolium
Multivariate Analysis
Bone Marrow
Education

ASJC Scopus subject areas

  • Hematology

Cite this

Greenberg, P., Cox, C., LeBeau, M. M., Fenaux, P., Morel, P., Sanz, G., ... Bennett, J. (1997). International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood, 89(6), 2079-2088.

International scoring system for evaluating prognosis in myelodysplastic syndromes. / Greenberg, Peter; Cox, Christopher; LeBeau, Michelle M.; Fenaux, Pierre; Morel, Pierre; Sanz, Guillermo; Sanz, Miguel; Vallespi, Teresa; Hamblin, Terry; Oscier, David; Ohyashiki, Kazuma; Toyama, Keisuke; Aul, Carlo; Mufti, Ghulam; Bennett, John.

In: Blood, Vol. 89, No. 6, 15.03.1997, p. 2079-2088.

Research output: Contribution to journalArticle

Greenberg, P, Cox, C, LeBeau, MM, Fenaux, P, Morel, P, Sanz, G, Sanz, M, Vallespi, T, Hamblin, T, Oscier, D, Ohyashiki, K, Toyama, K, Aul, C, Mufti, G & Bennett, J 1997, 'International scoring system for evaluating prognosis in myelodysplastic syndromes', Blood, vol. 89, no. 6, pp. 2079-2088.
Greenberg P, Cox C, LeBeau MM, Fenaux P, Morel P, Sanz G et al. International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood. 1997 Mar 15;89(6):2079-2088.
Greenberg, Peter ; Cox, Christopher ; LeBeau, Michelle M. ; Fenaux, Pierre ; Morel, Pierre ; Sanz, Guillermo ; Sanz, Miguel ; Vallespi, Teresa ; Hamblin, Terry ; Oscier, David ; Ohyashiki, Kazuma ; Toyama, Keisuke ; Aul, Carlo ; Mufti, Ghulam ; Bennett, John. / International scoring system for evaluating prognosis in myelodysplastic syndromes. In: Blood. 1997 ; Vol. 89, No. 6. pp. 2079-2088.
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abstract = "Despite multiple disparate prognostic risk analysis systems for evaluating clinical outcome for patients with myelodysplastic syndrome (MDS), imprecision persists with such analyses. To attempt to improve on these systems, an International MDS Risk Analysis Workshop combined cytogenetic, morphological, and clinical data from seven large previously reported risk- based studies that had generated prognostic systems. A global analysis was performed on these patients, and critical prognostic variables were re- evaluated to generate a consensus prognostic system, particularly using a more refined bone marrow (SM) cytogenetic classification. Univariate analysis indicated that the major variables having an impact on disease outcome for evolution to acute myeloid leukemia were cytogenetic abnormalities, percentage of BM myeloblasts, and number of cytopenias; for survival, in addition to the above, variables also included age and gender. Cytogenetic subgroups of outcome were as follows: 'good' outcomes were normal, - Y alone, del(5q) alone, del(20q) alone; 'poor' outcomes were complex (ie, ≤3 abnormalities) or chromosome 7 anomalies; and 'intermediate' outcomes were other abnormalities. Multivariate analysis combined these cytogenetic subgroups with percentage of BM blasts and number of cytopenias to generate a prognostic model. Weighting these variables by their statistical power separated patients into distinctive subgroups of risk for 25{\%} of patients to undergo evolution to acute myeloid leukemia, with: low (31{\%} of patients), 9.4 years; intermediate-1 (INT-1; 39{\%}), 3.3 years; INT-2 (22{\%}), 1.1 years; and high (8{\%}), 0.2 year. These features also separated patients into similar distinctive risk groups for median survival: low, 5.7 years; INT-1, 3.5 years; INT-2, 1.2 years; and high, 0.4 year. Stratification for age further improved analysis of survival. Compared with prior risk-based classifications, this International Prognostic Scoring System provides an improved method for evaluating prognosis in MDS. This classification system should prove useful for more precise design and analysis of therapeutic trials in this disease.",
author = "Peter Greenberg and Christopher Cox and LeBeau, {Michelle M.} and Pierre Fenaux and Pierre Morel and Guillermo Sanz and Miguel Sanz and Teresa Vallespi and Terry Hamblin and David Oscier and Kazuma Ohyashiki and Keisuke Toyama and Carlo Aul and Ghulam Mufti and John Bennett",
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AU - Sanz, Miguel

AU - Vallespi, Teresa

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AU - Oscier, David

AU - Ohyashiki, Kazuma

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