What is the prognosis of Myelodysplastic Syndrome (MDS) transforming into Acute Myeloid Leukemia (AML)?

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From the Guidelines

The prognosis for Myelodysplastic Syndrome (MDS) transforming into Acute Myeloid Leukemia (AML) is generally poor, with a median survival ranging from 5 to 12 months for patients with MDS-EB or MDS-EB-T, and approximately 30-40% of MDS patients progressing to AML within 6 months to 2 years after diagnosis. Several factors influence this prognosis, including the subtype of MDS, with higher-risk subtypes such as those with excess blasts having a greater likelihood and faster rate of progression to AML 1. Genetic factors also play a crucial role, with patients having complex karyotypes or TP53 mutations having a particularly poor prognosis 1. Age and overall health status significantly impact treatment options and outcomes, with older patients or those with comorbidities often being ineligible for intensive therapies such as allogeneic stem cell transplantation 1. The only potentially curative treatment for MDS-AML is allogeneic stem cell transplantation, which can improve long-term survival to 20-30% in eligible patients 1. However, for many MDS patients, treatment often focuses on supportive care and less intensive chemotherapy regimens to manage symptoms and potentially slow disease progression. Regular monitoring of blood counts and bone marrow examinations are crucial for MDS patients to detect early signs of progression to AML, allowing for timely intervention and treatment planning 1. Key factors to consider in the prognosis and treatment of MDS-AML include:

  • The subtype of MDS and its associated risk of progression to AML
  • Genetic factors, such as complex karyotypes or TP53 mutations
  • Age and overall health status, including comorbidities
  • The potential for allogeneic stem cell transplantation as a curative treatment option
  • The importance of regular monitoring and timely intervention to manage disease progression. In terms of specific numbers, approximately 25% of MDS-EB cases and 55% of MDS-EB-T cases undergo transformation to AML in the first year, increasing to 35% and 65%, respectively, within 2 years 1. The proportion of MDS patients who transform to AML ranges from 5% to 15% in the low-risk group to 40% to 50% in the high-risk group 1. Overall, the prognosis for MDS transforming into AML is poor, and treatment should be individualized based on patient-specific factors, including age, overall health status, and genetic characteristics.

From the Research

Prognosis of Myelodysplastic Syndrome (MDS) Transforming into Acute Myeloid Leukemia (AML)

The prognosis of MDS transforming into AML is generally poor. According to a study published in 2004 2, the median survival time for patients with MDS-AML was 6 months, with a low complete remission rate of 31.25%.

Factors Affecting Prognosis

Several factors can affect the prognosis of MDS transforming into AML, including:

  • Age: Patients under 40 years old have a higher risk of leukemic transformation 2
  • Pancytopenia of 3 lineages: Presence of pancytopenia is associated with a higher risk of leukemic transformation 2
  • Percentage of blasts in bone marrow: More than 15% blasts in the bone marrow is associated with a higher risk of leukemic transformation 2
  • Abnormal karyotypes: Presence of at least two abnormal karyotypes is associated with a higher risk of leukemic transformation 2
  • Treatment with combined chemotherapy: Treatment with combined chemotherapy is associated with a higher risk of leukemic transformation 2

Treatment Options

Treatment options for MDS-AML are limited, and the prognosis is generally poor. According to a study published in 2022 3, hypomethylating agents such as azacitidine or decitabine are first-line therapy for higher-risk MDS. However, a study published in 2014 4 found that the outcome of AML evolving from MDS after hypomethylating agent failure is poor, with a median survival of 21 weeks.

Survival Rates

The survival rates for MDS-AML are generally low. According to a study published in 2004 2, the median survival time for patients with MDS-AML was 6 months. A study published in 2019 5 found that the median overall survival of MDS patients treated with decitabine was 8 months.

Key Findings

Key findings from the studies include:

  • MDS has a high risk of developing into AML, either gradually or rapidly 2
  • Patients with MDS-AML have specific biological characteristics and a worse prognosis 2
  • The outcome of AML evolving from MDS after hypomethylating agent failure is poor 4
  • Decitabine is effective and relatively safe in treating MDS and AML, but patients with agranulocytosis and severe anemia are prone to have poor survival 5

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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