Therapy-related myelodysplastic syndromes deserve specific diagnostic sub-classification and risk-stratification—an approach to classification of patients with t-MDS View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2020-06-29

AUTHORS

A. Kuendgen, M. Nomdedeu, H. Tuechler, G. Garcia-Manero, R. S. Komrokji, M. A. Sekeres, M. G. Della Porta, M. Cazzola, A. E. DeZern, G. J. Roboz, D. P. Steensma, A. A. Van de Loosdrecht, R. F. Schlenk, J. Grau, X. Calvo, S. Blum, A. Pereira, P. Valent, D. Costa, A. Giagounidis, B. Xicoy, H. Döhner, U. Platzbecker, C. Pedro, M. Lübbert, I. Oiartzabal, M. Díez-Campelo, M. T. Cedena, S. Machherndl-Spandl, M. López-Pavía, C. D. Baldus, M. Martinez-de-Sola, R. Stauder, B. Merchan, A. List, C. Ganster, T. Schroeder, M. T. Voso, M. Pfeilstöcker, H. Sill, B. Hildebrandt, J. Esteve, B. Nomdedeu, F. Cobo, R. Haas, F. Sole, U. Germing, P. L. Greenberg, D. Haase, G. Sanz

ABSTRACT

In the current World Health Organization (WHO)-classification, therapy-related myelodysplastic syndromes (t-MDS) are categorized together with therapy-related acute myeloid leukemia (AML) and t-myelodysplastic/myeloproliferative neoplasms into one subgroup independent of morphologic or prognostic features. Analyzing data of 2087 t-MDS patients from different international MDS groups to evaluate classification and prognostication tools we found that applying the WHO classification for p-MDS successfully predicts time to transformation and survival (both p < 0.001). The results regarding carefully reviewed cytogenetic data, classifications, and prognostic scores confirmed that t-MDS are similarly heterogeneous as p-MDS and therefore deserve the same careful differentiation regarding risk. As reference, these results were compared with 4593 primary MDS (p-MDS) patients represented in the International Working Group for Prognosis in MDS database (IWG-PM). Although a less favorable clinical outcome occurred in each t-MDS subset compared with p-MDS subgroups, FAB and WHO-classification, IPSS-R, and WPSS-R separated t-MDS patients into differing risk groups effectively, indicating that all established risk factors for p-MDS maintained relevance in t-MDS, with cytogenetic features having enhanced predictive power. These data strongly argue to classify t-MDS as a separate entity distinct from other WHO-classified t-myeloid neoplasms, which would enhance treatment decisions and facilitate the inclusion of t-MDS patients into clinical studies. More... »

PAGES

835-849

Journal

TITLE

Leukemia

ISSUE

3

VOLUME

35

Author Affiliations

  • Department of Hematology, Oncology, and Clinical Immunology, University Hospital Duesseldorf, Duesseldorf, Germany
  • Department of Laboratory Hematology, Institut Català d’Oncologia Hospital GermansTrias I Pujol, Badalona, Spain
  • Boltzmann Institute for Leukemia Research, Hanusch Hospital, Vienna, Austria
  • Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA
  • Department of Malignant Hematology, H Lee Moffitt Cancer Center, Tampa, FL, USA
  • Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
  • Cancer Center - IRCCS Humanitas Research Hospital & Humanitas University, Rozzano - Milan, Italy
  • Department of Hematology Oncology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
  • Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
  • Weill Cornell Medicine and The New York Presbyterian Hospital, New York, NY, USA
  • Dana-Farber Cancer Institute, Boston, MA, USA
  • Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
  • Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
  • Hematological Citology Laboratory, Pathology Department, Hospital del Mar, GRETNHE, IMIM Hospital del Mar Research Institute, Barcelona, Spain
  • Service of Hematology, University Hospital Lausanne, Lausanne, Switzerland
  • Hemotherapy and Hemostasis Department, Hospital Clínic de Barcelona IDIBAPS, Barcelona, Spain
  • Department of Internal Medicine I, Division of Hematology & Hemostaseology and Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
  • Hematopathology Section, Hospital Clínic de Barcelona IDIBAPS, Barcelona, Spain
  • Department of Oncology, Hematology and Palliative Care, Marienhospital Duesseldorf, Duesseldorf, Germany
  • Clinical Hematology Department, Institut Català d’Oncologia, Hospital Germans Trias i Pujol, Badalona, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Bellaterra, Spain
  • Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
  • University Hospital Leipzig, Leipzig, Germany
  • Clinical Hematology Department, Hospital del Mar, Barcelona, Spain
  • Department of Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, Freiburg, Germany
  • Clinical Hematology Department, Hospital Universitario Araba, Vitoria-Gasteiz, Spain
  • Clinical Hematology Department, Hospital Universitario de Salamanca (HUSA), Salamanca, Spain
  • Clinical Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
  • 1st. Internal Department – Hematology with stem cell transplants, Hemostaseology and Medical Oncology, Elisabethinen Hospital, Linz, Austria
  • Clinical Hematology Department, Hospital General Universitari de València, Valencia, Spain
  • Department of Hematology and Oncology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
  • Clinical Hematology Department, Hospital Parc Taulí, Sabadell, Spain
  • Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
  • Department of Hematology, University Hospital Vall d´Hebrón, Barcelona, Spain
  • Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
  • Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
  • Hanusch Krankenhaus Wien, Vienna, Austria
  • Medizinische Universität Graz, Graz, Austria
  • Institute of Human Genetics, University Duesseldorf, Duesseldorf, Germany
  • Clinical Hematology Department, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
  • Clinical Hematology Department, Hospital Quirón Teknon, Barcelona, Spain
  • MDS Group, Josep Carreras Leukemia Research Institute, Barcelona, Spain
  • Stanford University Cancer Center, Stanford, CA, USA
  • Clinical Hematology Department, Hospital Universitari I Politècnic la Fe, Valencia, Spain
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1038/s41375-020-0917-7

    DOI

    http://dx.doi.org/10.1038/s41375-020-0917-7

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1128827022

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/32595214


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    26 schema:description In the current World Health Organization (WHO)-classification, therapy-related myelodysplastic syndromes (t-MDS) are categorized together with therapy-related acute myeloid leukemia (AML) and t-myelodysplastic/myeloproliferative neoplasms into one subgroup independent of morphologic or prognostic features. Analyzing data of 2087 t-MDS patients from different international MDS groups to evaluate classification and prognostication tools we found that applying the WHO classification for p-MDS successfully predicts time to transformation and survival (both p < 0.001). The results regarding carefully reviewed cytogenetic data, classifications, and prognostic scores confirmed that t-MDS are similarly heterogeneous as p-MDS and therefore deserve the same careful differentiation regarding risk. As reference, these results were compared with 4593 primary MDS (p-MDS) patients represented in the International Working Group for Prognosis in MDS database (IWG-PM). Although a less favorable clinical outcome occurred in each t-MDS subset compared with p-MDS subgroups, FAB and WHO-classification, IPSS-R, and WPSS-R separated t-MDS patients into differing risk groups effectively, indicating that all established risk factors for p-MDS maintained relevance in t-MDS, with cytogenetic features having enhanced predictive power. These data strongly argue to classify t-MDS as a separate entity distinct from other WHO-classified t-myeloid neoplasms, which would enhance treatment decisions and facilitate the inclusion of t-MDS patients into clinical studies.
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