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Blood Adv. 2018 Aug 28;2(16):2079-2089. doi: 10.1182/bloodadvances.2018020495.

Early platelet count kinetics has prognostic value in lower-risk myelodysplastic syndromes.

Author information

1
Département d'Hématologie, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris and Université Paris Diderot, Paris, France.
2
Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom.
3
Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
4
Division Hematology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece.
5
Division Hematology, Department of Medicine, Karolinska Institute, Stockholm, Sweden.
6
Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
7
Centro de Investigación Biomédica en Red Cáncer, Instituto Carlos III, Madrid, Spain.
8
Department of Clinical Hematology, Institute of Hematology and Blood Transfusion, Praha, Czech Republic.
9
Department of Internal Medicine V (Haematology and Oncology), Innsbruck Medical University, Innsbruck, Austria.
10
Department of Haematology, Oncology and Clinical Immunology, Universitätsklinik Düsseldorf, Düsseldorf, Germany.
11
Department of Medicine A, Tel Aviv Sourasky (Ichilov) Medical Center, Sackler Medical Faculty, Tel Aviv University, Tel Aviv, Israel.
12
Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands.
13
Department of Haematology, Oncology and Internal Medicine, Warsaw Medical University, Warsaw, Poland.
14
Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
15
Department of Haematology, Aarhus University Hospital, Aarhus, Denmark.
16
Department of Hematology, Hospital da Luz, Lisbon, Portugal.
17
Clinic of Hematology-Clinical Center of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.
18
Division of Hematology, Department of Internal Medicine, Merkur University Hospital, Zagreb, Croatia.
19
Servicio d'Hematología. Hospital Universitario Central de Asturias, Oviedo, Spain.
20
Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom.
21
Service d'Hématologie, Centre Hospitalier Universtaire Brabois Vandoeuvre, Nancy, France.
22
St. James's Institute of Oncology, Leeds Teaching Hospitals, Leeds, United Kingdom; and.
23
Department of Tumor Immunology-Nijmegen Center for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.

Abstract

Prognosis of lower-risk (International Prognostic Scoring System [IPSS] low/intermediate-1) myelodysplastic syndrome (MDS) is heterogeneous and relies on steady-state assessment of cytopenias. We analyzed relative drops in neutrophil and platelet counts during the first 6 months of follow-up of lower-risk MDS patients. We performed a landmark analysis of overall survival (OS) of lower-risk MDS patients prospectively included in the European LeukaemiaNet MDS registry having a visit at 6 ± 1 month from inclusion to assess the prognostic relevance of relative drops in neutrophils and platelets, defined as (count at landmark - count at inclusion)/count at inclusion. Of 2102 patients, 807 were eligible for the stringent 6-month landmark analysis. Median age was 73 years. Revised IPSS was very low, low, and intermediate/higher in 26%, 43%, and 31% of patients, respectively. A relative drop in platelets >25% at landmark predicted shorter OS (5-year OS, 21.9% vs 48.6% with platelet drop ≤25%, P < 10-4), regardless of baseline IPSS-revised or absolute platelet counts. Relative neutrophil drop >25% had no significant impact on OS. We built a classifier based on red blood cell transfusion dependence (RBC-TD) and relative platelet drop >25% at landmark. Patients with none (62%), either (27%), or both criteria (11%) had 5-year OS of 53.3%, 32.7%, and 9.0%, respectively (P < 10-4). This classifier was validated in an independent cohort of 335 patients. Combining relative platelet drop >25% and RBC-TD at 6 months from diagnosis provides an inexpensive and noninvasive way to predict outcome in lower-risk MDS. This study was registered at www.clinicaltrials.gov as #NCT00600860.

PMID:
30126931
PMCID:
PMC6113605
DOI:
10.1182/bloodadvances.2018020495
[Indexed for MEDLINE]
Free PMC Article

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