A Revised International Prognostic Scoring System of 3.5 Points Stratifies Patients with Myelodysplastic Syndromes into 2 Risk Categories

▪ Introduction: Although the IPSS-R stratifies patients with MDS in five risk groups and includes an intermediate-risk group, treatment options are commonly based on the division of the patients into low-risk MDS (LR-MDS) and high-risk MDS (HR-MDS). However, it is not well-defined which cut-off bett...

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Published in:Blood 2020-11, Vol.136 (Supplement 1), p.9-10
Main Authors: Montoro, Maria Julia, Ortega, Margarita, Villacampa, Guillermo, Bernal, Teresa, Pomares, Helena, Mora Casterá, Elvira, Molero, Antonieta, Vilorio, Laura, Tormo, Mar, Diaz-Beyá, Marina, Brayan, Merchan, Jerez, Andres, Rivero, Eugenia, Lys, Maria Jose, Cárcel, Paula, Bargay, Joan, Ramos, Fernando, Xicoy, Blanca, Diez-Campelo, Maria, Valcarcel, David
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Language:English
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Summary:▪ Introduction: Although the IPSS-R stratifies patients with MDS in five risk groups and includes an intermediate-risk group, treatment options are commonly based on the division of the patients into low-risk MDS (LR-MDS) and high-risk MDS (HR-MDS). However, it is not well-defined which cut-off better classifies patients in LR-MDS vs. HR-MDS and, specifically, to which category belongs the intermediate IPSS-R group. A prior study from the International Working Group for the Prognosis of MDS suggested that a cut-off of ≤3.5 points was adequate to identify LR-MDS patients. The aim of the study was to establish the point of the IPSS-R that best divides patients in LR-MDS and HR-MDS and describe the clinical characteristics and outcomes of the intermediate-risk subgroup. Methods: All patients diagnosed with MDS according to the WHO 2008 from the Spanish Registry of Myelodysplastic Syndromes between 1980 and 2019 were included. Patients with an OS ≥30 months were defined as LR-MDS. The prognostic risk of the patients was performed according to the IPSS-R. The IPSS-R point that dichotomized the patients was obtained in agreement with the value that maximized the log-rank test in the overall survival (OS) analysis and the Youden index. Kaplan-Meier test was used for survival analysis, Cox model to obtain the hazard ratios (HR) and competing risk analysis for the evolution to acute myeloid leukemia (AML). Statistical analysis was performed by software R. Results: Among 8,107 MDS included in the registry, 4,103 had all the variables to be classified according to the IPSS-R (patients characteristics detailed in table 1). The median follow-up for survivors was 52.7 months (CI95% 49.9-56.5). Median OS was 52.9 months (CI95% 50.2-56). The IPSS-R cut-off that best identified LR-MDS patients was ≤3.5 (75% accuracy to predict OS ≥30 months). According to this value, 2,830 (69%) and 1,273 (31%) patients were classified as LR-MDS and HR-MDS, with a median OS of 75 months (CI95% 71.1-80.7) and 15.4 months (CI95% 14.5-17.4), respectively; [HR= 3.68 (95%CI 3.37-4.02); p
ISSN:0006-4971
1528-0020
DOI:10.1182/blood-2020-136197