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Validation of the MD Anderson Prognostic Risk Model for patients with myelodysplastic syndrome
Author(s) -
Komrokji Rami S.,
CorralesYepez Maria,
Al Ali Najla,
KharfanDabaja Mohammad,
Padron Eric,
Fields Teresa,
Lancet Jeffrey E.,
List Alan F.
Publication year - 2011
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.26567
Subject(s) - medicine , myelodysplastic syndromes , international prognostic scoring system , oncology , risk assessment , bone marrow , computer security , computer science
BACKGROUND: The proposed MD Anderson Risk Model Score (MDAS) for myelodysplastic syndromes (MDS) refines outcome discrimination compared with the International Prognostic Scoring System (IPSS). We applied the MDAS to Moffitt Cancer Center (MCC) MDS patients to validate its prognostic utility. METHODS: This was a retrospective analysis of MDS cases, as defined by World Health Organization criteria, from the Moffitt database, with confirmatory chart review. RESULTS: A total of 775 patients evaluated between January 2001 and December 2009 were included. Patients were reclassified by MDAS as low (20.6%), intermediate‐1 (31%), intermediate‐2 (21%), high risk (16.1%), and unknown (11.2%). Median overall survival (OS) from diagnosis was 92, 49, 27, and 14 months for low, intermediate‐1, intermediate‐2, and high‐risk MDAS groups, respectively ( P < .005). Median OS from referral was 61, 28, 15, and 8 months ( P < .005), respectively. Among 484 patients classified by IPSS as low or intermediate‐1 risk, 25% were up‐staged as intermediate‐2 or high risk by MDAS; 4 prognostically distinct subgroups were identified among lower risk IPSS categories with median OS of 93, 53, 31, and 18 months ( P < .005). Among 201 intermediate‐2 or high‐risk IPSS patients, 15.4% were down‐staged to intermediate‐1 by MDAS, with 3 groups identified by MDAS having median OS of 33, 23, and 14 months. Acute myeloid leukemia transformation rate was highest among high‐risk MDAS (50.4%). In Cox regression analysis, higher risk MDAS predicted inferior OS (hazard ratio 1.42; P < .005) independent of IPSS. CONCLUSIONS: Our data validated MDAS' prognostic value. MDAS is complementary to IPSS and refines prognostic precision. Cancer 2011;. © 2011 American Cancer Society.