Novel approaches in the classification and risk assessment of patients with myelodysplastic syndromes-clinical implication

INTRODUCTION: New prognostic systems have been proposed aimed at improving the ability to predict survival and progression in myelodysplastic syndome (MDS) patients, as well as to select the accurate therapy.PURPOSE: The aim of this study was to determine the prognostic score for patients with MDS, diagnosed in the Hematology Clinic, University hospital, Varna, comparing different prognostic scoring systems.MATERIALS AND METHODS: 92 patients with MDS, diagnosed between 2004 and 2012 were included in the study. The mediana of age was 72 (20-91 years), 87% >60 years of age, 52 men and 41 women. The prognostic score was determined according to IPSS, WPSS, MDACSS. The parameters assessed were WHO type, karyotype, cytopenias, percentage of marrow blasts, age, performing status and transfusion dependence.RESULTS: Cytogenetic studies were performed in 100% of patients. Abnormalities were found In 34.8%, the most common-del-5q (14.6%), -Y (4.5%), complex karyotype (8%), +8 (2.2%). Patients were distributed according to the cytogenetic risk -low-87.2%, intermediate-7.7%, high-5.1%. According to IPSS 41% of the patients were with low risk, 34%-Int-1, 16%-Int-2, high-9%.  WPSS distributed the patients in 5 groups: very low-11%, low risk-43%, int-21%, high-20%, very high-5%. According to MDACSS 14% of the patients were with low, 54%-Int-1, 18%-Int2, 13% with high risk.CONCLUSION: Significant correlation was found between the risk groups and AML transformation and survival. However, the comparison between the different scoring systems demonstrated the advantage of prognostic systems, based on broader range of clinical parameters in better distribution of intermediate risk patients and the precise determination of high and very high risk.