Prognostic Factors and Life Expectancy in Myelodysplastic Syndromes Classified According to WHO Criteria: A Basis for Clinical Decision Making

TLDR

The study aimed to evaluate the prognostic value of the WHO classification of myelodysplastic syndromes, assess key prognostic factors within WHO subgroups, and estimate mortality and life expectancy to inform clinical decision making. A retrospective analysis of 467 de novo MDS patients diagnosed at the University of Pavia (1992–2002) examined clinical and hematologic features at diagnosis, overall survival, and leukemia‑free survival. Survival differed among WHO subgroups, age and sex influenced non‑blast MDS, cytogenetics was the sole IPSS prognostic factor, transfusion dependence and iron overload shortened survival, and the WHO classification combined with cytogenetics guided transplant decisions and identified low‑risk isolated erythroid dysplasia patients suitable for conservative management.

Abstract

The aim of this study was to evaluate the prognostic value of the WHO proposal, to assess the role of the main prognostic factors in myelodysplastic syndromes (MDSs) classified into WHO subgroups, and to estimate mortality (standardized mortality ratio [SMR]) and life expectancy in these groups as a basis for clinical decision making.Four hundred sixty-seven patients who were diagnosed as having de novo MDS at the Division of Hematology, University of Pavia (Pavia, Italy), between 1992 and 2002, were evaluated retrospectively for clinical and hematologic features at diagnosis, overall survival (OS), and progression to leukemia (leukemia-free survival).Significant differences in survival were noted between patients with refractory anemia (RA), refractory cytopenia with multilineage dysplasia, RA with excess blasts, type 1 (RAEB-1), and RAEB-2. The effect of demographic factors on OS was observed in MDS patients without excess blasts (age, P = .001; sex, P = .006), as in the general population. The mortality of RA patients 70 years or older did not differ significantly from that of the general population (SMR, 1.62; P = .06). Cytogenetics was the only International Prognostic Scoring System variable showing a prognostic value in MDS classified into WHO subgroups. Transfusion-dependent patients had a significantly shorter survival than patients who did not require transfusions (P < .001). Developing a secondary iron overload significantly affected the survival of transfusion-dependent patients (P = .003. )This data show that the WHO classification of MDSs has a relevant prognostic value. This classification, along with cytogenetics, might be useful in decisions regarding transplantation. MDS with isolated erythroid lineage dysplasia identifies a subset of truly low-risk patients, for whom a conservative approach is advisable.