Prognostic factors and scoring systems in myelodysplastic syndromes.

BACKGROUND AND
OBJECTIVE: Great prognostic heterogeneity complicates therapy-planning and a correct evaluation of clinical trials in myelodysplastic syndromes (MDS). Thus, the development of a prognostic classification of MDS is of major clinical relevance, especially when the advanced age of most patients and the aggressiveness of the curative treatment modalities currently available are considered. This review summarizes the results of different studies focusing on prognostic factors in MDS and deals with the pros and cons of prognostic scoring systems that have been recently developed. It also discusses the prognostic factors of particular subtypes of patients and those isolated with certain treatment options. EVIDENCE AND INFORMATION SOURCES: The authors of the present review have been working in different areas of the field of MDS for several years, have contributed original papers on the prognostic factors and therapy of these disorders, and have taken part in the recent International MDS Risk Analysis Workshop that has resulted in the development of the International Prognostic Scoring System (IPSS) for MDS. STATE OF THE ART AND PERSPECTIVES: The percentage of marrow blasts, cytogenetic pattern and number and degree of cytopenias are the most powerful prognostic indicators in MDS. Although some limitations are evident, the recently developed scoring systems, and particularly the IPSS, are extremely useful for predicting survival and acute leukemic risk in individuals with MDS and should be incorporated to the design and analysis of therapeutic trials in these disorders. A risk-adapted treatment strategy is now possible and highly recommended for MDS patients.