BACKGROUND: Thrombocytopenia is very common in myelodysplastic syndrome (MDS); however, its clinical impact in low-risk patients remains controversial. METHODS: The authors analyzed the incidence and prognostic significance of thrombocytopenia at diagnosis in 2565 de novo MDS patients included in the Spanish MDS Registry. RESULTS: Thrombocytopenia (platelet count <100 × 10(9) /L) was identified in 842 patients (32.8%). Severe thrombocytopenia (platelet count <30 × 10(9) /L) was observed in 7.1% of patients and was significantly associated with a higher-risk World Health Organization subtype (P = .026) and intermediate-2/high-risk International Prognostic Scoring System (IPSS) score (P = .046). Severe thrombocytopenia was the most important prognostic factor and had negative effects on the low/intermediate-1 risk group. Median overall survival of patients with a platelet count <30 and ≥ 30 × 10(9) /L was 16 months and 71 months, respectively (hazard ratio, 4.66; 95% confidence interval, 2.74-7.90; P < .0001). The negative effect of severe thrombocytopenia in low/intermediate-1 risk patients was caused by increased risk of bleeding. CONCLUSIONS: MDS patients with low/intermediate-1 IPSS risk score and severe thrombocytopenia should no longer be regarded as low risk, and must be considered for disease-altering approaches at diagnosis.
BACKGROUND:Thrombocytopenia is very common in myelodysplastic syndrome (MDS); however, its clinical impact in low-risk patients remains controversial. METHODS: The authors analyzed the incidence and prognostic significance of thrombocytopenia at diagnosis in 2565 de novo MDSpatients included in the Spanish MDS Registry. RESULTS:Thrombocytopenia (platelet count <100 × 10(9) /L) was identified in 842 patients (32.8%). Severe thrombocytopenia (platelet count <30 × 10(9) /L) was observed in 7.1% of patients and was significantly associated with a higher-risk World Health Organization subtype (P = .026) and intermediate-2/high-risk International Prognostic Scoring System (IPSS) score (P = .046). Severe thrombocytopenia was the most important prognostic factor and had negative effects on the low/intermediate-1 risk group. Median overall survival of patients with a platelet count <30 and ≥ 30 × 10(9) /L was 16 months and 71 months, respectively (hazard ratio, 4.66; 95% confidence interval, 2.74-7.90; P < .0001). The negative effect of severe thrombocytopenia in low/intermediate-1 risk patients was caused by increased risk of bleeding. CONCLUSIONS:MDSpatients with low/intermediate-1 IPSS risk score and severe thrombocytopenia should no longer be regarded as low risk, and must be considered for disease-altering approaches at diagnosis.
Authors: Peter L Greenberg; Heinz Tuechler; Julie Schanz; Guillermo Sanz; Guillermo Garcia-Manero; Francesc Solé; John M Bennett; David Bowen; Pierre Fenaux; Francois Dreyfus; Hagop Kantarjian; Andrea Kuendgen; Alessandro Levis; Luca Malcovati; Mario Cazzola; Jaroslav Cermak; Christa Fonatsch; Michelle M Le Beau; Marilyn L Slovak; Otto Krieger; Michael Luebbert; Jaroslaw Maciejewski; Silvia M M Magalhaes; Yasushi Miyazaki; Michael Pfeilstöcker; Mikkael Sekeres; Wolfgang R Sperr; Reinhard Stauder; Sudhir Tauro; Peter Valent; Teresa Vallespi; Arjan A van de Loosdrecht; Ulrich Germing; Detlef Haase Journal: Blood Date: 2012-06-27 Impact factor: 22.113
Authors: Aristoteles Giagounidis; Ghulam J Mufti; Pierre Fenaux; Mikkael A Sekeres; Jeffrey Szer; Uwe Platzbecker; Andrea Kuendgen; Gianluca Gaidano; Wieslaw Wiktor-Jedrzejczak; Kuolung Hu; Paul Woodard; Allen S Yang; Hagop M Kantarjian Journal: Cancer Date: 2014-04-04 Impact factor: 6.860
Authors: G Garcia-Manero; S D Gore; S Kambhampati; B Scott; A Tefferi; C R Cogle; W J Edenfield; J Hetzer; K Kumar; E Laille; T Shi; K J MacBeth; B Skikne Journal: Leukemia Date: 2015-10-07 Impact factor: 11.528