IMPACT OF PREVIOUS TRANSFUSION AND COMORBIDITIES IN THE IPSS-R FOR OVERALL SURVIVAL
(Abstract release date: 05/19/16)
EHA Library. Diaz Varela N. 06/09/16; 132767; E1218
Dr. Nicolas Diaz Varela
Contributions
Contributions
Abstract
Abstract: E1218
Type: Eposter Presentation
Background
Myelodisplastic sindromes(MDS)are heterogeneus clonal hematological disorders, with different clinical outcome.The revised international prognostic score system(IPSS-R)showed improvement prognostic power as compared to IPSS. Disease and patient related factors not considered in IPSS-R are emerging as relevant for prognosis of individual patients with MDS.
Aims
This is a retropective cohort study to validate the IPSS-R and evaluate the impact of new variables in a MDS patients serie, wondering if adds any prognostic survival prediction at diagnosis.
Methods
Data from 339 patients diagnosed with MDS in 11 hospitals sited in Galicia, Spain from January 1,2007 to december 31,2011.End of the follow-up time was december 18,2012. The patients were registered in the central area citogenetic database and were reclassified according to 2008 WHO Criteria.Data of 30 patients with secondary MDS were included and CMML or AML diagnosys were excluded.Patients treatment was heterogeneous (conservative,supportive treatment, chemotherapy, IMIDs, hypometilant agents, BMT and others).The study was approved by the regional ethical committee.
Results
Population:44% females and 56% males.Median age:78 years(range 29-100).Median follow-up time:1,7 years.Median survival time:3,5 years.According to 2008 WHO classification:14%CRDU,11%RARS, 31%RCMD,8%RCDMSA,8% MDS(del5q),12%RAEB-1, 12%RAEB-2,1%U-MDS.Included 1% fibrotic and 2% hipoplastic MDS.According IPSS, patients were classified as low risk:43%,(median survival-MS-:5 years),intermediate-1:37%(MS:3,2 years),intermediate-2:16% and high risk:4%(MS:5, 3.2, 1 and 0.3 years respectively).According IPSS-R:low IPSS risk patients were shifted to very low,low and intermediate risk (43%,53% and 4%. MS not reached, 4.4 and 3.6 years respectively).Intermediate-1 patients spread into very low(5%), low(54%),intermediate(31%),high, and very high risk(8% and 1%, MS:1 and 0.6 year). Intermediate-2 IPSS patients were classified into intermediate(26%),high(46%)and very high(28%)risk.High risk IPSS patients were staged in very high IPSS-R risk. The 3 and 5 year ROC survival curves and AUC was better for the IPSS-R than the IPSS(p<0.001)but not at 1 year. We studied 4 new variables at diagnosis to improve the survival prognostic IPSS-R prediction. Ferritin and LDH serum levels, comorbidities (measured by MDS-CI index)and previous RBC transfusión (at least two RBC in the 4 previous months).Univariate analisys not showed statistical significance for the serum LDH.The multivariate analisys didn´t it for serum ferritin levels.Data available for 327 patients for previous transfusion showed 46 individuals transfused (14%).Risk stratification according MDS-CI: 339 patients:41%low risk,43% intermediate risk,16% high risk. The most frecuent observed comorbidities were:cardiac disease(35%),other tumour(15%)pulmonary(14%),renal(9%),hepatic(2%). ROC curves and AUC at 1,3 and 5 years showed better survival prediction power for IPSS-R if we added the two last variables individually and increase if we add the two variables simultaneously(p<0.001).
Conclusion
IPSS-R provides pronostic power for OS compared to IPSS but not includes emerging relevant clinical events. Comorbidities exert a negative impact in life expectancy on MDS patients.Intrinsic MDS characterystics like anemia can worse patients sickness.Previous transfusion can reflect more aggressive disease or late diagnosis.Late iron develop has a negative impact in morbidity/mortality.Our study showed that adds the two variables improve the IPSS-R prognostic power for OS and helps in clinical decisión making.
Session topic: E-poster
Keyword(s): Comorbidities, MDS, Prognostic, Transfusion
Type: Eposter Presentation
Background
Myelodisplastic sindromes(MDS)are heterogeneus clonal hematological disorders, with different clinical outcome.The revised international prognostic score system(IPSS-R)showed improvement prognostic power as compared to IPSS. Disease and patient related factors not considered in IPSS-R are emerging as relevant for prognosis of individual patients with MDS.
Aims
This is a retropective cohort study to validate the IPSS-R and evaluate the impact of new variables in a MDS patients serie, wondering if adds any prognostic survival prediction at diagnosis.
Methods
Data from 339 patients diagnosed with MDS in 11 hospitals sited in Galicia, Spain from January 1,2007 to december 31,2011.End of the follow-up time was december 18,2012. The patients were registered in the central area citogenetic database and were reclassified according to 2008 WHO Criteria.Data of 30 patients with secondary MDS were included and CMML or AML diagnosys were excluded.Patients treatment was heterogeneous (conservative,supportive treatment, chemotherapy, IMIDs, hypometilant agents, BMT and others).The study was approved by the regional ethical committee.
Results
Population:44% females and 56% males.Median age:78 years(range 29-100).Median follow-up time:1,7 years.Median survival time:3,5 years.According to 2008 WHO classification:14%CRDU,11%RARS, 31%RCMD,8%RCDMSA,8% MDS(del5q),12%RAEB-1, 12%RAEB-2,1%U-MDS.Included 1% fibrotic and 2% hipoplastic MDS.According IPSS, patients were classified as low risk:43%,(median survival-MS-:5 years),intermediate-1:37%(MS:3,2 years),intermediate-2:16% and high risk:4%(MS:5, 3.2, 1 and 0.3 years respectively).According IPSS-R:low IPSS risk patients were shifted to very low,low and intermediate risk (43%,53% and 4%. MS not reached, 4.4 and 3.6 years respectively).Intermediate-1 patients spread into very low(5%), low(54%),intermediate(31%),high, and very high risk(8% and 1%, MS:1 and 0.6 year). Intermediate-2 IPSS patients were classified into intermediate(26%),high(46%)and very high(28%)risk.High risk IPSS patients were staged in very high IPSS-R risk. The 3 and 5 year ROC survival curves and AUC was better for the IPSS-R than the IPSS(p<0.001)but not at 1 year. We studied 4 new variables at diagnosis to improve the survival prognostic IPSS-R prediction. Ferritin and LDH serum levels, comorbidities (measured by MDS-CI index)and previous RBC transfusión (at least two RBC in the 4 previous months).Univariate analisys not showed statistical significance for the serum LDH.The multivariate analisys didn´t it for serum ferritin levels.Data available for 327 patients for previous transfusion showed 46 individuals transfused (14%).Risk stratification according MDS-CI: 339 patients:41%low risk,43% intermediate risk,16% high risk. The most frecuent observed comorbidities were:cardiac disease(35%),other tumour(15%)pulmonary(14%),renal(9%),hepatic(2%). ROC curves and AUC at 1,3 and 5 years showed better survival prediction power for IPSS-R if we added the two last variables individually and increase if we add the two variables simultaneously(p<0.001).
Conclusion
IPSS-R provides pronostic power for OS compared to IPSS but not includes emerging relevant clinical events. Comorbidities exert a negative impact in life expectancy on MDS patients.Intrinsic MDS characterystics like anemia can worse patients sickness.Previous transfusion can reflect more aggressive disease or late diagnosis.Late iron develop has a negative impact in morbidity/mortality.Our study showed that adds the two variables improve the IPSS-R prognostic power for OS and helps in clinical decisión making.
Session topic: E-poster
Keyword(s): Comorbidities, MDS, Prognostic, Transfusion
Abstract: E1218
Type: Eposter Presentation
Background
Myelodisplastic sindromes(MDS)are heterogeneus clonal hematological disorders, with different clinical outcome.The revised international prognostic score system(IPSS-R)showed improvement prognostic power as compared to IPSS. Disease and patient related factors not considered in IPSS-R are emerging as relevant for prognosis of individual patients with MDS.
Aims
This is a retropective cohort study to validate the IPSS-R and evaluate the impact of new variables in a MDS patients serie, wondering if adds any prognostic survival prediction at diagnosis.
Methods
Data from 339 patients diagnosed with MDS in 11 hospitals sited in Galicia, Spain from January 1,2007 to december 31,2011.End of the follow-up time was december 18,2012. The patients were registered in the central area citogenetic database and were reclassified according to 2008 WHO Criteria.Data of 30 patients with secondary MDS were included and CMML or AML diagnosys were excluded.Patients treatment was heterogeneous (conservative,supportive treatment, chemotherapy, IMIDs, hypometilant agents, BMT and others).The study was approved by the regional ethical committee.
Results
Population:44% females and 56% males.Median age:78 years(range 29-100).Median follow-up time:1,7 years.Median survival time:3,5 years.According to 2008 WHO classification:14%CRDU,11%RARS, 31%RCMD,8%RCDMSA,8% MDS(del5q),12%RAEB-1, 12%RAEB-2,1%U-MDS.Included 1% fibrotic and 2% hipoplastic MDS.According IPSS, patients were classified as low risk:43%,(median survival-MS-:5 years),intermediate-1:37%(MS:3,2 years),intermediate-2:16% and high risk:4%(MS:5, 3.2, 1 and 0.3 years respectively).According IPSS-R:low IPSS risk patients were shifted to very low,low and intermediate risk (43%,53% and 4%. MS not reached, 4.4 and 3.6 years respectively).Intermediate-1 patients spread into very low(5%), low(54%),intermediate(31%),high, and very high risk(8% and 1%, MS:1 and 0.6 year). Intermediate-2 IPSS patients were classified into intermediate(26%),high(46%)and very high(28%)risk.High risk IPSS patients were staged in very high IPSS-R risk. The 3 and 5 year ROC survival curves and AUC was better for the IPSS-R than the IPSS(p<0.001)but not at 1 year. We studied 4 new variables at diagnosis to improve the survival prognostic IPSS-R prediction. Ferritin and LDH serum levels, comorbidities (measured by MDS-CI index)and previous RBC transfusión (at least two RBC in the 4 previous months).Univariate analisys not showed statistical significance for the serum LDH.The multivariate analisys didn´t it for serum ferritin levels.Data available for 327 patients for previous transfusion showed 46 individuals transfused (14%).Risk stratification according MDS-CI: 339 patients:41%low risk,43% intermediate risk,16% high risk. The most frecuent observed comorbidities were:cardiac disease(35%),other tumour(15%)pulmonary(14%),renal(9%),hepatic(2%). ROC curves and AUC at 1,3 and 5 years showed better survival prediction power for IPSS-R if we added the two last variables individually and increase if we add the two variables simultaneously(p<0.001).
Conclusion
IPSS-R provides pronostic power for OS compared to IPSS but not includes emerging relevant clinical events. Comorbidities exert a negative impact in life expectancy on MDS patients.Intrinsic MDS characterystics like anemia can worse patients sickness.Previous transfusion can reflect more aggressive disease or late diagnosis.Late iron develop has a negative impact in morbidity/mortality.Our study showed that adds the two variables improve the IPSS-R prognostic power for OS and helps in clinical decisión making.
Session topic: E-poster
Keyword(s): Comorbidities, MDS, Prognostic, Transfusion
Type: Eposter Presentation
Background
Myelodisplastic sindromes(MDS)are heterogeneus clonal hematological disorders, with different clinical outcome.The revised international prognostic score system(IPSS-R)showed improvement prognostic power as compared to IPSS. Disease and patient related factors not considered in IPSS-R are emerging as relevant for prognosis of individual patients with MDS.
Aims
This is a retropective cohort study to validate the IPSS-R and evaluate the impact of new variables in a MDS patients serie, wondering if adds any prognostic survival prediction at diagnosis.
Methods
Data from 339 patients diagnosed with MDS in 11 hospitals sited in Galicia, Spain from January 1,2007 to december 31,2011.End of the follow-up time was december 18,2012. The patients were registered in the central area citogenetic database and were reclassified according to 2008 WHO Criteria.Data of 30 patients with secondary MDS were included and CMML or AML diagnosys were excluded.Patients treatment was heterogeneous (conservative,supportive treatment, chemotherapy, IMIDs, hypometilant agents, BMT and others).The study was approved by the regional ethical committee.
Results
Population:44% females and 56% males.Median age:78 years(range 29-100).Median follow-up time:1,7 years.Median survival time:3,5 years.According to 2008 WHO classification:14%CRDU,11%RARS, 31%RCMD,8%RCDMSA,8% MDS(del5q),12%RAEB-1, 12%RAEB-2,1%U-MDS.Included 1% fibrotic and 2% hipoplastic MDS.According IPSS, patients were classified as low risk:43%,(median survival-MS-:5 years),intermediate-1:37%(MS:3,2 years),intermediate-2:16% and high risk:4%(MS:5, 3.2, 1 and 0.3 years respectively).According IPSS-R:low IPSS risk patients were shifted to very low,low and intermediate risk (43%,53% and 4%. MS not reached, 4.4 and 3.6 years respectively).Intermediate-1 patients spread into very low(5%), low(54%),intermediate(31%),high, and very high risk(8% and 1%, MS:1 and 0.6 year). Intermediate-2 IPSS patients were classified into intermediate(26%),high(46%)and very high(28%)risk.High risk IPSS patients were staged in very high IPSS-R risk. The 3 and 5 year ROC survival curves and AUC was better for the IPSS-R than the IPSS(p<0.001)but not at 1 year. We studied 4 new variables at diagnosis to improve the survival prognostic IPSS-R prediction. Ferritin and LDH serum levels, comorbidities (measured by MDS-CI index)and previous RBC transfusión (at least two RBC in the 4 previous months).Univariate analisys not showed statistical significance for the serum LDH.The multivariate analisys didn´t it for serum ferritin levels.Data available for 327 patients for previous transfusion showed 46 individuals transfused (14%).Risk stratification according MDS-CI: 339 patients:41%low risk,43% intermediate risk,16% high risk. The most frecuent observed comorbidities were:cardiac disease(35%),other tumour(15%)pulmonary(14%),renal(9%),hepatic(2%). ROC curves and AUC at 1,3 and 5 years showed better survival prediction power for IPSS-R if we added the two last variables individually and increase if we add the two variables simultaneously(p<0.001).
Conclusion
IPSS-R provides pronostic power for OS compared to IPSS but not includes emerging relevant clinical events. Comorbidities exert a negative impact in life expectancy on MDS patients.Intrinsic MDS characterystics like anemia can worse patients sickness.Previous transfusion can reflect more aggressive disease or late diagnosis.Late iron develop has a negative impact in morbidity/mortality.Our study showed that adds the two variables improve the IPSS-R prognostic power for OS and helps in clinical decisión making.
Session topic: E-poster
Keyword(s): Comorbidities, MDS, Prognostic, Transfusion
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