The myelodysplastic syndromes: predictive value of eight prognostic systems in 143 cases from a single institution

Background and Objective. Despite the fact that several prognostic systems for myelodysplastic syndromes (MDS) have been proposed, few studies have be en designed to test their effectiveness in independent patient populations. The aim of this study was to compare the prognostic value of 8 previously described prognostic systems in a series of consecutive MDS patients observ ed at a single institution over a 10-year period. Design and Methods. One hundred and forty-three patients were diagnosed as having myelodysplastic syndrome (MDS) according to the French-American-Brit ish (FAB) criteria. They were studied retrospectively in order to assess th e prognostic value of the FAB classification and 7 other prognostic systems . Results. On the basis of data at diagnosis, all investigated systems effect ively stratified patients into groups with different life expectancies and identified a subset of patients with poor clinical outcome. However, the sy stems had different outcomes concerning median survival of patients classif ied as low-risk, ranging from less than 3 years for the Mufti scoring syste m to more than 8 years for the FAB classification modified according to Ros ati et al. Moreover, patient distribution into different risk categories wa s quite different with the different prognostic systems. Interpretation and Conclusions. When applied to our case series, some of th e prognostic systems had a much lower prognostic value than in the patient population from which they derived. This evidence suggests that testing of prognostic systems in independent case series is necessary before using the systems in clinical practice. (C)1999, Ferrata Storti Foundation.