Panagiotis T Diamantopoulos1, Vasiliki Pappa2, Argiris Symeonidis3, Ioannis Kotsianidis4, Athanasios Galanopoulos5, Helen Papadaki6, Achilles Anagnostopoulos7, George Vassilopoulos8, Panagiotis Zikos9, Eleftheria Hatzimichael10, Maria Papaioannou11, Aekaterini Megalakaki12, Maria Kotsopoulou12, Panagiotis Repousis12, Maria Dimou13, Eleni Solomou3, Charalampos Pontikoglou6, Georgios Kyriakakis14, Dimitrios Tsokanas5, Menelaos-Konstantinos Papoutselis4, Sotirios Papageorgiou2, Alexandra Kourakli3, Panayiotis Panayiotidis13, Nora-Athina Viniou14. 1. Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: pandiamantopoulos@gmail.com. 2. Hematology Division, Second Department of Internal Medicine, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece. 3. Department of Internal Medicine, University Hospital of Patras, Rio, Greece. 4. Department of Hematology, University Hospital of Alexandroupolis, Alexandroupoli, Greece. 5. Department of Clinical Hematology, "G. Gennimatas" District General Hospital, Athens, Greece. 6. Haematology Laboratory, School of Medicine, University of Crete, Crete, Greece. 7. Hematology Department, General Hospital of Thessaloniki "George Papanikolaou", Thessaloniki, Greece. 8. Department of Hematology, Larissa University Hospital, University of Thessalia, Larissa, Greece. 9. Department of Hematology, "St Andrew" General Hospital, Patras, Greece. 10. Department of Haematology, University of Ioannina, Ioannina, Greece. 11. Hematology Department, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece. 12. Department of Hematology, Metaxa Anticancer Hospital, Piraeus, Greece. 13. First Propedeutic Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. 14. Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Abstract
BACKGROUND: Hypomethylating agents have altered the prognosis of myelodysplastic syndrome (MDS) so that long-term survival is now a feasible treatment goal. PATIENTS AND METHODS: We analyzed data from patients with MDS treated with 5-azacytidine recorded in the Hellenic 5-azacytidine registry. We divided patients, on the basis of their survival after 5-azacytidine initiation (OST), in groups of long-term survivors (Q3 and P90 group with OST above the third quartile and the 90th percentile of the whole group, respectively) and short-term survivors comprising the remaining patients, and compared the characteristics between the groups. The study included 626 patients, 157 in the Q3 group and 63 in the P90 group. RESULTS: Categorization per the International Prognostic Scoring System (IPSS), revised IPSS (IPSS-R), and World Health Organization-based prognostic scoring system (WPSS) was found to predict long-term survival, while multivariate analysis revealed that response to 5-azacytidine was the strongest predictor of long-term survival. Nevertheless, patients with hematologic improvement (HI) and stable disease (SD) were equally distributed in the groups of short- and long-term survival. CONCLUSION: SD should not be considered a poor treatment response and should not be grouped with failure, while HI offers similar prognosis to SD and thus should not be grouped with complete and partial remission. Patients with SD should continue treatment with 5-azacytidine.
BACKGROUND: Hypomethylating agents have altered the prognosis of myelodysplastic syndrome (MDS) so that long-term survival is now a feasible treatment goal. PATIENTS AND METHODS: We analyzed data from patients with MDS treated with 5-azacytidine recorded in the Hellenic 5-azacytidine registry. We divided patients, on the basis of their survival after 5-azacytidine initiation (OST), in groups of long-term survivors (Q3 and P90 group with OST above the third quartile and the 90th percentile of the whole group, respectively) and short-term survivors comprising the remaining patients, and compared the characteristics between the groups. The study included 626 patients, 157 in the Q3 group and 63 in the P90 group. RESULTS: Categorization per the International Prognostic Scoring System (IPSS), revised IPSS (IPSS-R), and World Health Organization-based prognostic scoring system (WPSS) was found to predict long-term survival, while multivariate analysis revealed that response to 5-azacytidine was the strongest predictor of long-term survival. Nevertheless, patients with hematologic improvement (HI) and stable disease (SD) were equally distributed in the groups of short- and long-term survival. CONCLUSION: SD should not be considered a poor treatment response and should not be grouped with failure, while HI offers similar prognosis to SD and thus should not be grouped with complete and partial remission. Patients with SD should continue treatment with 5-azacytidine.