Abstract
Background: Prognosis of very low, low and intermediate risk myelodosplastic syndromes (MDS) is heterogeneous. Recently, the EUMDS (European Leukemia Net Lower-Risk MDS) described that a 20% drop in platelet counts in the first 6 months after diagnosis of patients with lower risk MDS identifies a poor-risk population independently from the IPSS-R. Herein, we present the impact of an early drop in both platelet and neutrophil counts during the first 6 months after diagnosis in a population of patients with lower and intermediate IPSS-R risk MDS.
Patients and Methods: A total of 270 consecutive patients diagnosed with MDS (01/2010-12/2016) at the Catalan Institute of Oncology of Barcelona were included in the study. 201 patients were eligible for the study. Reasons for exclusion were: absence of a medical visit at 6 month or later on (n=9), higher-risk MDS patients (n=40) and patients under treatment with hypomethylating agents, lenalidomide or hydroxycarbamide at the follow up visit (n = 20). Patients were classified into two groups according to the presence or not of a 20% drop in neutrophils and platelets at time of or before the landmark time point. Landmark analysis was conducted at 6 months after diagnosis. We analyzed in our series the prognostic impact of early drop in neutrophils and plateletsin both overall survival (OS) and leukemia free survival (LFS).
Results: Median age at diagnosis was 75 years and 135 (67.2%) were male. According to the WHO 2008 classification, 3% of the patients were classified as CRDU, 7.5%RA, 48.8% RCMD, 8.5% RAEB‐1, 1%, RAEB‐2, 27.4% CMML, the remaining 4% were MDS‐U and isolated 5q deletion. Hemoglobin, neutrophiland platelet counts were of 11.2 g/dL (5.6-16.9) [median (range)], 2.71 x109/L (0.3-30), 149 x109/L (1-889), respectively; the percentage of bone marrow blast at diagnosis was 2% (0-13). 47% of the patients were diagnosed with a very low IPSS-R, 42% with a low IPSS-R and the remaining 11% with intermediate IPSS-R. At the time of last follow up, 74 (36.3%) patients had died and 17 (8.5%) had progressed to AML.The median time to the landmark blood test was 188 days (1QR: 160-218). Median follow-up from landmark was 31.4 months. Median relative drop in platelets was 2.4%. In univariate analysis male sex, number of cytopenias, IPSS-R, red blood cell transfusion dependency (RBC-TD) and a platelet drop >20% was associated with poorer OS (Figure 1). In multivariate testing, male sex, RBC-TD and a drop of platelets >20% within 6 months were independent significant parameters affecting survival (Table 1). Number of cytopenias, IPSS-R and RBC-TD were associated to an inferior LFS in univariate analysis. IPSS-R was the only independent adverse prognostic factor for LFS in the multivariate analysis. The combination of both RBC-TD and a platelet drop >20% at 6 month after diagnosis enabled us to identify a small subgroup of patients (6%) with a median OS of 20 months.
Conclusion: A 20% drop in platelet counts in the first 6 months after diagnosis is able to identify a poor-risk population of patients with MDS within the very low, low and intermediate-risk IPSS-R groups. As therapeutical decisions are based on prognostic risk assessment, the inclusion of this additional parameter may help to better tailor treatment strategies in these patients.
No relevant conflicts of interest to declare.
