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a For leukemic risk, only blasts in BM and karyotype are considered. bGood, normal, single abnormalities; poor, complex (&2) abnormalities.

cGood, normal, del(5q) only, del(20q) only, —Y only; intermediate, +8, single miscellaneous, double abnormalities; poor, very complex (>2) abnormalities, chromosome 7 abnormalities. dCytopenias, hemoglobin <10 g/dL, platelets <100 X 109/L, neutrophils <1.8 X 109/L

a For leukemic risk, only blasts in BM and karyotype are considered. bGood, normal, single abnormalities; poor, complex (&2) abnormalities.

cGood, normal, del(5q) only, del(20q) only, —Y only; intermediate, +8, single miscellaneous, double abnormalities; poor, very complex (>2) abnormalities, chromosome 7 abnormalities. dCytopenias, hemoglobin <10 g/dL, platelets <100 X 109/L, neutrophils <1.8 X 109/L

patients of 61-70 years, and 3.9 years in patients >70 years of age.9

Scoring systems, particularly the IPSS, are useful for defining the outcome and for designing and accurately analyzing therapeutic trials in patients with MDS. The IPSS has proven its value in several series of untreated patients,1057-60 and in series of patients treated with intensive chemotherapy61 or stem cell transplantation.62 Because of its clinical value and simplicity, the IPSS has gained universal acceptance and is now used to decide the most appropriate therapy in an individual patient and to design clinical trials in patients with MDS.

Figure 43.1 Surival (a) and freedom from AML evolution (b) of MDS patients related to their classification by the IPSS for MDS: low, intermediate-1, (Int-1), Int-2, and high (Kaplan-Meier curves). (Adapted from Greenberg P, Cox C, LeBeau MM, et al.: International scoring system for evaluating prognosis in myelodys-plastic syndromes. Blood 89:2079-2088,1997; used with permission)

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