Author(s): ,
Natalia Klimkovich
Department of pediatric oncology and hematology,Byelorussian Medical Academy of Post-Graduate Education,Minsk,Belarus
Olga Krasko
the Laboratory of Bioinformatics,United Institute of Informatics Problems of the National Academy of Sciences,Minsk,Belarus
Tatiana Kozarezova
Department of pediatric oncology and hematology,Byelorussian Medical Academy of Post-Graduate Education,Minsk,Belarus
EHA Library. Klimkovich N. Jun 15, 2019; 266959; PS1342
Mrs. Natalia Klimkovich
Mrs. Natalia Klimkovich

Abstract: PS1342

Type: Poster Presentation

Presentation during EHA24: On Saturday, June 15, 2019 from 17:30 - 19:00

Location: Poster area


The biological heterogeneity of MDS is a prerequisite of the need to search for additional criteria for predicting the development of all possible states and outcomes in MDS. For this purpose, it is possible to apply a model of multiple states, which reflects the development of the process in time and may describe a number of possible events and their dependencies.  This class of models is especially relevant for modeling the various activities that are dependent on the event, as the appearance of the disease and changes in the risk of death.

The analyze the clinical and laboratory characteristics of patients with MDS in order to provide additional prognostic criteria that will determine the risk of transitions between states of the disease - the transformation in leukemia – death.

The research included 70 patients from 18 to 60 years with primary MDS.  Detailed analysis of the variables   associated with outcome was performed by multistate survival model. We used three state model without recurrence: State 1- MDS, State 2 - transformation, State 3 - death.   We fitted Cox-Markov model for estimation relative hazard (HR) of variables associated with the transition from State 1 to State 2; from State 1 to State 3 and from State 2 to State 3. The analysis was performed with statistical tools R version 3.1.3 and packages survival, msSurv, p3state.msm.


After 12 months from the onset of the disease only 26.6% of patients remain in the  'State 1', after 60 months - only 11.3%. The probability of transformation  increases during the first 12 months and constitutes 45.1%, in 60 months - 49.3%. Probability of death constitutes 28.3% after 12 months and 39.4% after 60 months. The number of bone marrow blasts (p = 0,023), very poor risk group of IPSS-R (p = 0,004) and high expression of CD95 (p = 0,002) are unfavorable prognostic factors of death, irrespective of transformation in leukemia. The criteria of a high probability of transformation into acute leukemia are the young age of the patients (p = 0,031), low number of platelets (p = 0,005), the number of bone marrow blasts (p <0,001), the group of risk IPSS-R (p < 0,001) and low expression of CD95 (p <0,001). Only the expression of CD95 (p = 0,015) significantly affects on the probability of death after transformation into leukemia.  The results of multivariate analysis showed that, along with the parameters of IPSS-R, the expression of CD95 is an independent statistically significant predictor. This is the only predictor, which is associated with all three transitions, and its low value increases the risk of transition, as in a state of transformation (p = 0,004), and in a terminal state from the state of the disease (p = 0,003) and from the state of transformation into leukemia (p = 0,019). Along with this factor, on the probability of transformation into leukemia affects the young age of patients (p = 0,03), poor (p = 0,015) and very poor (p = 0,011) groups of risk of IPSS-R.

The model of the three states has shown that the risk of transformation from MDS to acute leukemia is associated with a younger age. A tendency to increase the risk of transition into the terminal state as without transformation, and after transformation with increasing age of patients.  The low value of expression of CD95 increases the risk of transition into the state of transformation and into the terminal state. 

Session topic: 10. Myelodysplastic syndromes - Clinical

Keyword(s): MDS, Prognosis, Survival

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