Scoring systems with karyotype analyses

Table 43.4 shows the main prognostic scoring systems proposed for MDS that include cytogenetic factors. The Lille group was the first to incorporate cytogenetics in a prognostic score of MDS,8 though only cases with complex abnormalities were considered as a high-risk group. An International MDS Risk Analysis Workshop was convened to improve the clinical and prognostic utility of scoring systems, to better define the cytogenetic risk categories, and to develop a consensus prognostic risk-based analysis system. This workshop published the International Prognostic Scoring System (IPSS) in 1997.9 The IPSS includes the proportion of blasts in the BM, cytogenetics, and number of cytopenias. Combining the risk scores for these three major variables allows patients to be stratified into four distinctive risk groups according to both survival and AML evolution; the risk scores are low (0 points), intermediate-1 (0.5-1.0 points), intermediated (1.5-2.0 points), and high (>2.5 points). The overall median survival was 5.7, 3.5, 1.2, and 0.4 years for low-, intermediate-1-, intermediate-2-, and high-risk patients, respectively (Figure 43.1). The time taken for 25% of the patients in each of the four risk groups to evolve toward acute leukemia was 9.4, 3.3, 1.1, and 0.2 years, respectively. Survival of low-risk patients was strongly related to age, with median survival times of 11.8 years in patients <60 years of age, 4.8 years in

Table 43.3 Prognostic scoring systems without karyotype analyses for patients with MDS

Scoring system

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