From the Guidelines
The prognosis of Myelodysplastic Syndrome (MDS) is highly variable, with survival ranging from a few weeks to several years, and the International Prognostic Scoring System (IPSS-R) is the most commonly used tool to predict outcomes, categorizing patients into five risk groups: very low, low, intermediate, high, and very high risk 1.
Prognostic Factors
The prognosis of MDS depends on several factors, including:
- Bone marrow blast percentage
- Cytogenetic abnormalities
- Hemoglobin level
- Platelet count
- Absolute neutrophil count
- Age, with older patients generally having poorer outcomes 1
- Specific genetic mutations, such as TP53, ASXL1, and RUNX1, which are associated with more aggressive disease 1
- Transfusion dependence, which indicates a worse prognosis 1
Risk Assessment
The IPSS-R scoring system is used to stratify patients into five risk groups, with clear differences in overall survival (OS) and risk of progression to acute myeloid leukemia (AML) 1.
Treatment and Outcomes
Treatment can modify prognosis, with allogeneic stem cell transplantation being the only potentially curative option, though it carries significant risks 1.
- Hypomethylating agents like azacitidine and decitabine can extend survival in higher-risk patients
- Lower-risk patients may benefit from erythropoiesis-stimulating agents, lenalidomide, or luspatercept to manage symptoms and improve quality of life
Disease Progression
Disease progression to AML occurs in approximately 25%–35% of MDS patients at 5 years, with higher-risk groups transforming more frequently and rapidly 1.
Quality of Life
The goal of treatment is not only to improve survival but also to improve quality of life, and treatment decisions should be individualized based on patient-related characteristics, such as age, performance status, and comorbidities 1.
From the Research
Prognosis of Myelodysplastic Syndromes (MDS)
The prognosis of MDS is highly variable, with a median survival time of about 30 months from the moment of diagnosis 2. Several factors can affect the prognosis, including:
- The degree of dysplasia and the percentage of blast cells in the blood and bone marrow
- Cytogenetic characteristics, such as chromosomal analysis
- The presence of somatic mutations
- The patient's age, gender, and comorbidities
- The response to treatment, such as 5-azacytidine
Predicting Prognosis
Several scoring systems can be used to predict the prognosis of MDS, including:
- The Revised International Prognostic Scoring System (IPSS-R) 2, 3
- The North American MDS Consortium scoring system 4 These systems take into account factors such as peripheral cytopenias, percentage of blasts in the bone marrow, and cytogenetic characteristics.
Treatment and Outcomes
Treatment for MDS can include:
- Transfusion therapy
- Iron depletion therapy
- Lenalidomide
- 5-azacytidine
- Allogeneic stem cell transplantation (alloSCT) The goal of treatment is to improve survival, decrease transfusion needs, and prevent transformation to acute myelogenous leukemia (AML) 3. However, the outcome of treatment can vary depending on the individual patient's characteristics and response to treatment. For example, patients who discontinue 5-azacytidine treatment due to primary resistance or adaptive resistance have a poorer overall survival compared to those who discontinue treatment due to planned alloSCT 4.
Factors Affecting Response to Treatment
Several factors can affect the response to treatment, including:
- Age and gender
- Baseline hematologic characteristics
- Comorbidities
- Cytogenetic and molecular profile
- Response to treatment with 5-azacytidine 5 Understanding these factors can help guide treatment decisions and improve patient outcomes.