Survival analysis and AML development in patients with de novo myelodysplastic syndromes: comparison of six different prognostic scoring systems

A number of prognostic scoring systems for patients with myelodysplastic sy ndromes (MDS) have been introduced in the past. In the present study, survi val and AML evolution were analyzed retrospectively in a total of 180 patie nts with de novo MDS (observation period: 1989-1999; median age: 71; range 27-93; f/m ratio: 1/1.2). Diagnoses were established according to FAB crite ria (RARS, n=37; RA, n=53; RAEB, n=50; RAEB-t, n=19; CMML, n=21). Six diffe rent multiparameter scoring systems (the Mufti, Aul, Sanz, Morel, and Toyam a scores, and the international prognostic scoring system [IPSS]) were appl ied. The Aul, Sanz, and Mufti scores were applied to all. 180 patients, Mor el and Toyama scores to 109 patients, and the IPSS to 102. As assessed by m ultivariate analysis, the percentage of bm-blasts, hemoglobin, platelet cou nt, neutrophil count, LDH, and karyotype were found to be independent singl e variables for survival, and bm-blasts, neutrophil count, platelet count, and karyotype for AML evolution. All prognostic scoring systems applied app eared to be highly predictive for survival and AML development (P <0.001). The highest predictive values were found for the Aul, Sanz, and Toyama scor es for overall survival, and the IPSS, Toyama, and Morel scores for AML-fre e survival. In summary, our data show that scoring systems are useful for p redicting overall and AML-free survival in patients with MDS. Karyotype-bas ed multiparameter systems appear to be particularly effective in defining M DS patients who are at high risk of transforming to leukemia.