IMEX   05356
INSTITUTO DE MEDICINA EXPERIMENTAL
Unidad Ejecutora - UE
congresos y reuniones científicas
Título:
Revised International Prognostic Scoring System (IPSS-R): Stratification for Myelodysplastic Syndrome (MDS) patients under hypomethylating treatment
Autor/es:
IABSTEBNER, MARCELO; FLORES, GABRIELA; NUCIFORA, ELSA; KORNBLIHTT, LAURA; ALFONSO, GRACIELA; ROSENHAIN, M; BENASAYAG, SILVIA; BARCALÁ, VIRNA; GARCÍA RIVELLO, HERNÁN; BELLI, CAROLINA
Lugar:
Berlin
Reunión:
Simposio; 12th International Symposium on Myelodysplastic Syndromes.; 2013
Institución organizadora:
Myelodysplastic Foundation
Resumen:
The International Prognostic Scoring System (IPSS) has recently been refined with new clinical features like marrow blast percentage, depth of cytopenia, and more differentiated cytogenetic subgroups (IPSS-R). The objective of this study is to examine the prognostic impact of IPSS-R on a group of patients under epigenetic treatment. We registered retrospectively adult MDS patients who had consecutively received hypomethylating treatment at any time of follow-up outside clinical trials for a period of 5 years (2007-2012). Patients on disease-modifying drugs, proliferative CMML, secondary MDS were ruled out and studied separately. Azacytidine or decitabine were administered at doses and indications well established. We took into account the following parameters: time from diagnosis to treatment (TTT), time to leukemia transformation (LFS), overall survival (OS), time from treatment to last follow up or death, number of cycles received and overall response rate (ORR). Data were analyzed using Kaplan-Meier, log-rank and Kendall’s tests. We evaluated sixty-five patients, median age was 68 (range 29-89), 72% male, and WHO subgroups were RA (4), RARS (1), del5q (2), RCMD (16), RCMDRS (2), RAEB-1 (7), RAEB-2 (12), AML/MDS (4), and CMML (17). Nineteen out of twenty-six (73%) classified as very high and high risk by IPSS-R were INT-1 or INT-2 with IPSS (Kendall’s tau=0,338) (Table 1). Median number of cycles received was 7 (range 1-27), ORR 41% (CR 14%, PR 10%, HI 17%, SD 8% and NR 51%). Thirty-one percent of patients progressed to AML; no significant difference in time after treatment and LFS (p=0,13) were found. Mortality rate was 52% and OS showed p=0,043 and TTT p=0,051 (table 2). Conclusion: Although population was heterogeneous, stratification and refinement of IPSS-R enabled us to identify a statistical difference in terms of OS (p=0,043) and a significant tendency in TTT (p=0,051) at baseline. Table 1. IPSS / IPSS-R stratification IPSS n = 65 L (8) INT-1 (34) INT-2 (16) H (7) IPSS-R L + VL (18) 8 10 -- -- IM (21) -- 19 2 -- H + VH (26) -- 5 14 7 Table 2. OS, LFS and DFS IPSS-R (Month) L + VL I H + VH OS 44 40 20 p=0,043 TTT 14 4 4 p=0,051 LFS 43 10 19 P=0,13