Influence of Acute Myeloid Leukemia Progression on the Prognosis of 831 Patients With Myelodysplastic Syndromes From the Argentine Database

Abstract

In our retrospective review of 831 patients with myelodysplastic syndromes, 158 developed progression with a very poor outcome (median survival after evolution, 3.5 months). The survival of patients with adverse karyotypes or with greater International Prognostic Scoring System-revised or World Health Organization-based Prognostic Scoring System risk was not affected when stratified by patients with and without evolution to acute myeloid leukemia. Our results could help in individualizing those patients who require more aggressive treatment. Background A large group of patients with myelodysplastic syndromes (MDS) will die of causes intrinsic to bone marrow failure. One third of patients will develop acute myeloid leukemia (AML), which is associated with an extremely poor outcome and a short survival. Our objectives were to analyze the prognostic variables and scoring systems in the attempt to determine the influence of progression on the overall survival of MDS patients. Patients and Methods We performed a retrospective analysis of 831 MDS patients, including those from the Argentine Registry. Results Of the 831 MDS patients, 158 (19.0%) experienced transformation, with a median overall survival of 17.9 months from diagnosis and 3.5 months after progression. The survival of patients with adverse karyotypes or greater risk, according to the International Prognostic Scoring System-revised (IPSS-R) or World Health Organization-based Prognostic Scoring System (WPSS) was not affected when stratified by patients with and without evolution to AML (P >.05). In contrast, the survival of lower risk patients was significantly reduced for those patients with progression to AML (P <.001) and those younger (P =.024) than those who died of non–AML-related causes. The intermediate-risk patients were heterogeneously distributed; however, an upgrade from a lower IPSS-R to a higher WPSS-hemoglobin risk category was associated with a worse outcome, not affected by progression (P =.420), with a median event-free survival of 16 months. Conclusion The use of the IPSS-R and WPSS systems simultaneously might help in identifying those patients who require more aggressive treatment. Nevertheless, more efforts are needed to improve the identification of those lower risk patients whose survival is significantly reduced by progression to AML.