A Prognostic Model for MDS that Accounts for Events Not Considered by the International Prognostic Scoring System (IPSS)
Slides from the journal article and transcribed comments from recent interviews with
Gail J Roboz, MD (10/6/09) and Steven D Gore, MD (10/8/09) below
Presentation discussed in this issue:
Kantarjian H et al. Development and validation of a new prognostic model for myelodysplastic syndrome (MDS) that accounts for events not considered by the International Prognostic Scoring System (IPSS). Blood 2008;112:635. Abstract
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GAIL J ROBOZ, MD: There has been a proliferation of prognostic scoring systems for MDS recently published in the literature. For example, before the commonly used system of the International Prognostic Scoring System, or IPSS, was developed, there were several years when many papers were published suggesting a variety of laboratory and clinical features that should be incorporated into MDS prognostication.
The IPSS system that is commonly used today does not accurately classify patients with lower-risk MDS. There is a wide survival range for these patients — some patients at lower risk may only live a few years and others may survive up to 10 or 11 years. The challenge becomes how to identify the patients within that technically classified lower-risk group who are not going to fare well. Another limitation of the IPSS is that it does not include secondary disease or proliferative MDS, including chronic myelomonocytic leukemia. There have been substantial efforts to try to determine which additional factors could be added to the IPSS that will allow for the inclusion of these subset groups and that will allow us to predict more accurately the prognosis of our patients.
This proposed model from MD Anderson may not be the final development in the area of prognostic systems for MDS, but it does incorporate factors such as performance status, platelet count and transfusion history. These are factors that can be important in determining the outcome of a patient with MDS that are not included in the IPSS prognostic system. I believe that if clinicians give their patients a score based on this new proposed system in addition to the IPSS system, they may elect to treat or to monitor very closely certain patients who in the past would have been otherwise labeled as low risk and asked to come back for follow-up after a year’s time.
STEVEN D GORE, MD: I believe that this study requires additional validation. This model demonstrates median survival times that are lower for the low-risk and intermediate-1 groups than what is shown by the IPSS model. The intermediate-2 and the high-risk groups show median survival times that are similar to those reported by IPSS. The new model does incorporate platelet counts that are thought by some to be possibly important, but I am uncertain as to the usefulness of this new model with the data that we have reported to date.
Dr Roboz is Associate Professor of Medicine and Director of the Leukemia Program at Weill Medical College of Cornell University at NewYork-Presbyterian Hospital in New York, New York.
Dr Gore is Professor of Oncology at Johns Hopkins University in Baltimore, Maryland.