Inclusion of RBC-Transfusion Dependency Can Improve the Prognostic Value of Revised-IPSS in MDS Patients

Autor: Chi-Hung Hui, James X Gray, Ian D. Lewis, Peter G Bardy, Devendra K Hiwase, John V. Reynolds, Peter B. Harrison, David M. Ross, Rakchha Chhetri, Monika M Kutyna, Shriram V. Nath, Deepak Singhal, Nicholas Wickham, Luen Bik To
Rok vydání: 2014
Předmět:
Zdroj: Blood. 124:1923-1923
ISSN: 1528-0020
0006-4971
DOI: 10.1182/blood.v124.21.1923.1923
Popis: Background: The Revised International Prognostic Scoring System (R-IPSS) stratifies MDS patients better than the original IPSS scoring system. Although RBC-transfusion dependency (RBC-TD) is associated with poor prognosis, it is not included in the R-IPSS. Another limitation of R-IPSS is that it is designed to assess the prognosis of patients only at the time of diagnosis; it does not provide prognostic guidance during the disease course. We hypothesise that the use of RBC-transfusion dependency status as a time-varying covariate improves R-IPSS. Aim: To assess the impact of RBC-TD as a time-varying covariate in addition to R-IPSS in predicting survival outcome of MDS patients. Materials and Methods: To match the patient selection criteria as in R-IPSS, primary MDS patients, AML (blast 20-30%) and CMML (WBC≤12x109/L) not treated with disease modifying agents or stem cell transplantation were included. RBC-TD was defined as RBC transfusion of at least 1 unit/8 weeks for at least 4 months (Malcovati et al ; JCO 2007). For the statistical analysis of overall survival (OS) measured in months since diagnosis, the Akaike Information Criterion (AIC) was used to assess the goodness-of-fit of a model. Landmark analyses at 6, 12 and 24 months after the diagnosis were also conducted; individuals who experienced the event (i.e. death) before the landmark time point were excluded. The remaining patients were then classified into two groups – RBC-TD noted at or before the landmark time point and transfusion independent at the landmark time point. Results: In our study, 295 patients met the inclusion criteria for analysis, their median age was 75 years (21-97 years) and 66% patients were male. The majority of patients were RCMD, RAEB1 and RAEB2. R-IPSS improved the risk stratification of MDS patients, predominantly for the IPSS-intermediate group (Table I). The median OS in R-IPSS Very Low, Low, Intermediate, High and Very High risk group was 87, 62, 28, 13 and 12 months respectively (p 80 years respectively). Of the 295 patients, 22 patients died and 1 lost-to-follow-up within four months of diagnosis; they did not complete the four months qualifying period for RBC-TD and hence were excluded from further analysis. Of the models tested, the four factor model which included R-IPSS, RBC-TD as a time-varying covariate, age and sex was best supported. RBC-TD (HR 5.5; P
Databáze: OpenAIRE
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