PROGNOSTIC FACTORS IN MYELODYSPLASTIC SYNDROMES - CRITICAL ANALYSIS OF THE IMPACT OF AGE AND GENDER AND FAILURE TO IDENTIFY A VERY-LOW-RISKGROUP USING STANDARD MORTALITY RATIO TECHNIQUES

We studied the prognostic value of age and gender by survival, and by standard mortality ratio (SMR) analyses, in 203 untreated patients wit h myelodysplastic syndromes (MDS); 57 refractory anaemia (RA), 23 refr actory anaemia with ringed sideroblasts, 41 refractory anaemia with ex cess blasts (RAEB), 3 RAEB in transformation (RAEB-T) and 79 chronic m yelomonocytic leukaemia (CMML), aged 23-89 years (median 69, M/F 0.5), who were all karyotyped. Median survival was 36 months, Adverse progn ostic factors were: high bone-marrow blast percentage. complex karyoty pe, low platelet count, age > 60 years, low or high WBC count, haemogl obin < 10 g/dl, male gender, However, the standard mortality ratio (i. e. mortality compared to that of an age- and sex-adjusted population) was not different between male and female patients. Patients < 60 had a higher SMR than older patients. Therefore the prognostic values of a ge and gender for survival in MDS patients may reflect, at least in pa rt, a characteristic of the population, Furthermore, even in low-risk groups defined by scoring system we were unable to define a subgroup o f patients with a mortality similar to that of the normal population, especially in MDS patients aged < 60.