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Report on outcomes of hypomethylating therapy for analyzing prognostic value of Revised International Prognostic Scoring System for patients with lower-risk myelodysplastic syndromes

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Abstract

The outcomes for patients with lower-risk myelodysplastic syndromes (LR-MDS) by the International Prognostic Scoring System (IPSS) vary widely. For more precise prognostication, this study evaluates the prognostic value of revised IPSS with the response to hypomethylating therapy (HMT). Using the Korean MDS Working Party database, treatment outcomes for 236 patients with HMT were retrospectively evaluated. The patients were then reclassified into very low/low (VL/L), intermediate (INT), and high (H) risk groups according to IPSS-R. According to the HMT response, the 3-year overall survival (OS) did not differ between the response group (37.9 ± 9.1 %) and the stable group (52.9 ± 6.6 %, p = 0. 782). When reclassifying according to IPSS-R, 42 patients (20.8 %) were reclassified into the H risk group. Most of them did not have benefit from continued HMT and progressed to secondary failure. The median OS was 59.0 months (range, 40.0–77.9 months) for the VL/L risk group, 31 months (range, 22.7–439.3 months) for the INT risk group, and 20.0 months (range, 15.9–24.1 months) for the H risk group (p < 0.001). In the multivariate analysis, the following factors were associated with survival: age ≥ 65 (HR = 1.515, p = 0.023), ECOG ≥ 2 (HR = 2.968, p < 0.001), H risk group according to IPSS-R (HR = 3.054, p < 0.001), P/VP cytogenetic risk according to IPSS-R (HR = 4.912, p = 0.003), and transformation to AML (HR = 2.158, p = 0.002). If IPSS-R reclassifies LR-MDS patients as H risk, these patients should be considered for early allo-HCT, regardless of the current benefits from HMT.

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Acknowledgments

S.K.S and J.H.M contributed equally to this study as corresponding authors.

Authors’ contribution

As the first author, Y.J.L collected and interpreted the data, drafted the article, and critically revised for important intellectual content; S.W.P, J.S.A, H.J.K, M.K.S, J.S.C, H.J.S, W.S.L, S.M.L, Y.D.J, H.K, H.S.L, Y.S.K, and Y.Y.C performed the treatment and supplied the data; S.K.S and J.H.M interpreted the data, drafted the article, critically revised for important intellectual content, and approved the final version for submission.

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Authors and Affiliations

  1. Department of Hematology/Oncology, Kyungpook National University Hospital, 130 Dongduk-Ro, Jung-Gu, Daegu, 41944, South Korea

    Yoo Jin Lee, Sung Woo Park, In Hee Lee, Joon Ho Moon & Sang Kyun Sohn

  2. Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, Gwangju, South Korea

    Jae Sook Ahn & Hyeoung Joon Kim

  3. Department of Hematology/Oncology, Busan National University Hospital, Busan, South Korea

    Joo Seop Chung & Ho Jin Shin

  4. Department of Hematology/Oncology, Inje University Busan Baik Hospital, Busan, South Korea

    Won Sik Lee & Sang Min Lee

  5. Department of Hematology/Oncology, Inje University Haewoondae Baik Hospital, Busan, South Korea

    Young Don Joo

  6. Department of Hematology/Oncology, Ulsan University Hospital, Ulsan, South Korea

    Hawk Kim

  7. Department of Hematology/Oncology, Kosin University Gospel Hospital, Busan, South Korea

    Ho Sup Lee & Yang Soo Kim

  8. Department of Hematology/Oncology, Daegu Catholic University Medical Center, Daegu, South Korea

    Yoon Young Cho

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  1. Yoo Jin Lee
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Correspondence to Joon Ho Moon or Sang Kyun Sohn.

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Supplementary Table. Outcomes of hypomethylating therapy according to IPSS-R (DOC 39 kb)

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Lee, Y.J., Park, S.W., Lee, I.H. et al. Report on outcomes of hypomethylating therapy for analyzing prognostic value of Revised International Prognostic Scoring System for patients with lower-risk myelodysplastic syndromes. Ann Hematol 95, 1795–1804 (2016). https://doi.org/10.1007/s00277-016-2759-y

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