A four-parameter index of marrow dysplasia has predictive value for survival in myelodysplastic syndromes

Marrow dysplasia is a major characteristic of patients with myelodysplastic syndrome (MDS), along with marrow blastosis, cytopenia and cytogenetic ano malies. However, the impact of the degree of marrow dysplasia on survival h as not been fully assessed. In this retrospective analysis of 111 patients selected according to the IPSS criteria of MDS diagnosis, the presence or a bsence of 21 dysplasia characteristics recognizable in bone marrow smears s tained by the May-Grunwald-Giemsa method was correlated with patient surviv al. Using Cox proportional hazards regression analysis, megaloblastosis (ME GALO), neutrophil agranularity (AGRAN) and hypogranularity (HYPOGRAN) were highly significant predictors (p < 0.005), and Pelger-Huet anomaly (PELGHUE T) a significant predictor (p = 0.05), of patient survival. The regression analysis yielded a dysplasia-based risk index (D1) where DI = 1.26 MEGALO 0.82 AGRAN - 1.08 HYPOGRAN + 0.45 PELGHUET. The two subgroups of 60 and 47 patients with DI less than or equal to 0 and > 0 showed highly significant differences in median survivals (2.6 vs 1.1 yrs; p <0.0001). Multivariate analysis further showed that DI offered additional predictive power that wa s independent of that provided by the IPSS (p=0.002 and 0.001 respectively) . Analysis of survival curves stratified for IPSS and DI showed that the ad ditional predictive power offered by inclusion of the DI essentially concer ned the IPSS low/INT-1 risk categories. Further stratification for age did not improve survival prediction. The data indicate that a set of 4 dysplasi a parameters can offer some prediction for survival of MDS patients in addi tion to that provided by the IPSS. Further multicenter studies should aim a t including some form of evaluation of the degree of dysplasia in prognosti c systems.