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1.
Clin Lymphoma Myeloma Leuk ; 18(7): 469-474.e1, 2018 07.
Article in English | MEDLINE | ID: mdl-29807802

ABSTRACT

BACKGROUND: The prognosis of patients with lower-risk myelodysplastic syndrome (LR-MDS) is very heterogeneous. In addition to survival estimates, identification of factors related to the probability of leukemic progression might help prognosis assessment. PATIENTS AND METHODS: The present study is a retrospective analysis of 409 patients with primary LR-MDS. The probability of leukemic progression was estimated in the competing risk framework by the cumulative incidence method considering death without acute myeloid leukemia (AML) as a competing event. RESULTS: Sixty-six patients (16.1%) progressed to AML. The following covariates influenced the probability of leukemic progression in a multivariate competing risk regression model: intermediate karyotype versus diploid or chromosome 5 deletion, 5% to 9% bone marrow blast percentage, platelet count <50 × 10e9/L and age younger than 75 years. CONCLUSION: According to these, a predictive model is proposed, which categorizes patients with different probability of leukemic progression (P < .001). Validation of these results might help prognostic refinement of patients with LR-MDS.


Subject(s)
Leukemia, Myeloid, Acute/epidemiology , Leukemia, Myeloid, Acute/etiology , Myelodysplastic Syndromes/epidemiology , Myelodysplastic Syndromes/pathology , Adult , Aged , Aged, 80 and over , Biomarkers , Combined Modality Therapy , Disease Progression , Female , Humans , Incidence , Leukemia, Myeloid, Acute/diagnosis , Male , Middle Aged , Models, Statistical , Myelodysplastic Syndromes/therapy , Probability , Prognosis , Risk Assessment , Risk Factors
2.
Leuk Lymphoma ; 58(8): 1893-1902, 2017 08.
Article in English | MEDLINE | ID: mdl-27951729

ABSTRACT

Chronic medical diseases, evaluated by several comorbidities indexes have been reported to influence on overall survival in patients with myelodysplastic syndrome (MDS). However, these studies included patients with lower and higher-risk disease by IPSS. This study retrospectively evaluates the role of comorbidities (evaluated by the MDS comorbidity index; MDS-CI) together with clinical parameters in a series of 232 patients with LR-MDS (defined as either an IPSS score of low/intermediate-1 and favorable cytogenetic categories by IPSS-R). In multivariate analysis, together with age >75 years, diabetes requiring therapy and hemoglobin <10 g/dL; the incorporation of comorbidities by the MDS-CI (HR = 2.5; p< 0.0001) were independently associated to the probability of nonleukemic death (NLD). The combination of these variables allowed development of a model, which categorizes patients in three different groups with significantly different probability of NLD overtime (p< 0.001). This integrated score confirms the importance of comorbidities at diagnosis of patients with LR-MDS.


Subject(s)
Myelodysplastic Syndromes/diagnosis , Myelodysplastic Syndromes/epidemiology , Aged , Aged, 80 and over , Biomarkers , Bone Marrow/pathology , Cause of Death , Comorbidity , Female , Humans , Incidence , Leukocyte Count , Male , Middle Aged , Myelodysplastic Syndromes/mortality , Prevalence , Prognosis , Retrospective Studies , Risk , Survival Analysis , Symptom Assessment
3.
Clin Lymphoma Myeloma Leuk ; 15(4): 236-44, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25487600

ABSTRACT

BACKGROUND: The prognosis of myelodysplastic syndromes (MDS) and acute myeloid leukaemia (AML) is very heterogeneous. PATIENTS AND METHODS: We analyzed the prognostic value of several genes in a cohort of 85 MDS and AML patients. RESULTS: Overexpression of glycogen synthase 1 and macrophage migration inhibitory factor genes had an adverse outcome in multivariate analysis (P = .003 and P < .001, respectively). Furthermore, the higher expression of myelocytomatosis oncogene was associated with a lower response to azacitidine (P = .03). CONCLUSION: In the current study we identified a specific gene expression profile as prognostic factors for response to azacitidine and survival in MDS and AML.


Subject(s)
Gene Expression , Genes, myc , Glycogen Synthase/genetics , Intramolecular Oxidoreductases/genetics , Leukemia, Myeloid, Acute/drug therapy , Leukemia, Myeloid, Acute/genetics , Macrophage Migration-Inhibitory Factors/genetics , Myelodysplastic Syndromes/drug therapy , Myelodysplastic Syndromes/genetics , Aged , Aged, 80 and over , Antimetabolites, Antineoplastic/therapeutic use , Azacitidine/therapeutic use , Gene Expression Profiling , Humans , Hypoxia/genetics , Leukemia, Myeloid, Acute/diagnosis , Leukemia, Myeloid, Acute/mortality , Middle Aged , Myelodysplastic Syndromes/diagnosis , Myelodysplastic Syndromes/mortality , Prognosis , Survival Analysis , Treatment Outcome
4.
Clin Lymphoma Myeloma Leuk ; 14(1): 80-6, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24220615

ABSTRACT

Incidence, etiology, and outcome of infectious episodes in patients with myeloid neoplasms receiving azacitidine are uncertain, with no prospective data available in this group of patients. The aim of the current study was to analyze the incidence and factors related to the probability of infection in a cohort of patients with myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) treated with azacitidine who did not receive any type of antimicrobial prophylaxis. Significantly, the group of patients who received prior intensive chemotherapy had more infectious episodes (P = 10(-4)), and particularly, invasive aspergillosis (P = .015), than patients who received frontline azacitidine. Primary antifungal prophylaxis might be recommended in MDS and AML patients receiving azacitidine as salvage therapy after intensive regimens.


Subject(s)
Antifungal Agents/therapeutic use , Antimetabolites, Antineoplastic/therapeutic use , Azacitidine/therapeutic use , Leukemia, Myeloid, Acute/drug therapy , Leukemia, Myeloid, Acute/microbiology , Myelodysplastic Syndromes/drug therapy , Myelodysplastic Syndromes/microbiology , Adult , Aged , Aged, 80 and over , Humans , Incidence , Middle Aged , Retrospective Studies , Salvage Therapy/methods
5.
Clin Lymphoma Myeloma Leuk ; 13(2): 144-52, 2013 Apr.
Article in English | MEDLINE | ID: mdl-23137720

ABSTRACT

UNLABELLED: Prognosis of myelodysplastic syndromes (MDS) is an area of ongoing interest. Identification of patients with poor outcome in the categories of lower risk disease is critical. In this study, we classify a cohort of 332 lower risk MDS into 3 groups with differences in survival and risk for leukemic progression that could drive treatment approaches to improve prognosis in a fraction of these patients. BACKGROUND: Prognosis of MDS and particularly in patients categorized as lower risk (< 10% blasts or low and intermediate-1 International Prognostic Scoring System [IPSS]) is very heterogeneous and includes patients with very different outcomes with current scoring systems. Recently, a new cytogenetic classification has been proposed for the revised IPSS in predicting the outcome for MDS. PATIENTS AND METHODS: To evaluate the prognostic significance of multiple variables for survival and risk of progression to acute myeloid leukemia, we analyzed baseline characteristics of 332 lower risk MDS patients within the lower risk cytogenetic categories by IPSS and the recent proposal for the new cytogenetic classification. RESULTS: In multivariate analysis, severity of cytopenias, age > 60 years, bone marrow blasts (5%-9%) and transfusion dependency significantly influenced outcome. The combination of these variables allowed development of a model which categorizes patients in 3 different groups with median survival of 95, 44, and 13 months for groups 1, 2, and 3, respectively (P < .001). In addition, this score also stratified patients for their risk for leukemic progression, estimated at 2 years in 3.1%, 7.6%, and 21.3% for each group (P = .024). CONCLUSION: Although karyotype remains the main prognostic factor in MDS, the current study identifies clinical parameters predicting outcome among patients with the better cytogenetic profile. Degree of cytopenias, blasts 5%-9% and transfusion dependence might identify a subset of patients within the nonadverse karyotype, in which early or more aggressive approaches could possibly be required to improve survival or prevent disease progression.


Subject(s)
Bone Marrow Cells/pathology , Chromosome Aberrations , Leukemia, Myeloid, Acute/etiology , Leukemia, Myeloid, Acute/mortality , Myelodysplastic Syndromes/diagnosis , Myelodysplastic Syndromes/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Disease Progression , Female , Humans , Karyotype , Male , Middle Aged , Prognosis , Young Adult
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