Early transfusion patterns improve the Molecular International Prognostic Scoring System (IPSS-M) prediction in myelodysplastic syndromes Journal Article

  


Authors: Creignou, M.; Bernard, E.; Gasparini, A.; Tranberg, A.; Todisco, G.; Moura, P. L.; Ejerblad, E.; Nilsson, L.; Garelius, H.; Antunovic, P.; Lorenz, F.; Rasmussen, B.; Walldin, G.; Mortera-Blanco, T.; Jansson, M.; Tobiasson, M.; Elena, C.; Ferrari, J.; Gallì, A.; Pozzi, S.; Malcovati, L.; Edgren, G.; Crowther, M. J.; Jädersten, M.; Papaemmanuil, E.; Hellström-Lindberg, E.
Article Title: Early transfusion patterns improve the Molecular International Prognostic Scoring System (IPSS-M) prediction in myelodysplastic syndromes
Abstract: Background: The Molecular International Prognostic Scoring System (IPSS-M) is the new gold standard for diagnostic outcome prediction in patients with myelodysplastic syndromes (MDS). This study was designed to assess the additive prognostic impact of dynamic transfusion parameters during early follow-up. Methods: We retrieved complete transfusion data from 677 adult Swedish MDS patients included in the IPSS-M cohort. Time-dependent erythrocyte transfusion dependency (E-TD) was added to IPSS-M features and analyzed regarding overall survival and leukemic transformation (acute myeloid leukemia). A multistate Markov model was applied to assess the prognostic value of early changes in transfusion patterns. Results: Specific clinical and genetic features were predicted for diagnostic and time-dependent transfusion patterns. Importantly, transfusion state both at diagnosis and within the first year strongly predicts outcomes in both lower (LR) and higher-risk (HR) MDSs. In multivariable analysis, 8-month landmark E-TD predicted shorter survival independently of IPSS-M (p < 0.001). A predictive model based on IPSS-M and 8-month landmark E-TD performed significantly better than a model including only IPSS-M. Similar trends were observed in an independent validation cohort (n = 218). Early transfusion patterns impacted both future transfusion requirements and outcomes in a multistate Markov model. Conclusion: The transfusion requirement is a robust and available clinical parameter incorporating the effects of first-line management. In MDS, it provides dynamic risk information independently of diagnostic IPSS-M and, in particular, clinical guidance to LR MDS patients eligible for potentially curative therapeutic intervention. © 2024 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.
Keywords: survival; adult; cancer survival; controlled study; aged; aged, 80 and over; middle aged; gene mutation; major clinical study; overall survival; allogeneic stem cell transplantation; clinical feature; disease course; mortality; outcome assessment; follow up; gold standard; markov chains; cohort analysis; practice guideline; prediction; risk assessment; sweden; myelodysplastic syndrome; diagnosis; blood transfusion; erythrocyte transfusion; dna extraction; therapy; azacitidine; myelodysplastic syndromes; thrombocyte transfusion; dna methyltransferase 3a; transfusion; refractory anemia with excess blasts; international prognostic scoring system; refractory cytopenia with multilineage dysplasia; very elderly; humans; prognosis; human; male; female; article; markov chain; swedish citizen; ipss-m
Journal Title: Journal of Internal Medicine
Volume: 296
Issue: 1
ISSN: 0954-6820
Publisher: Wiley Blackwell  
Date Published: 2024-07-01
Start Page: 53
End Page: 67
Language: English
DOI: 10.1111/joim.13790
PUBMED: 38654517
PROVIDER: scopus
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85191151261&doi=10.1111%2fjoim.13790&partnerID=40&md5=5d79ba2cac66778d7b7ef8249ffb7f91
Notes: Article -- Source: Scopus
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MSK Authors
  1. Elli Papaemmanuil
    206 Papaemmanuil
  2. Elsa Bernard
    49 Bernard
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