Refinement of the international prognostic scoring system (IPSS) by including LDH as an additional prognostic variable to improve risk assessment ... View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2005-09-29

AUTHORS

U Germing, B Hildebrandt, M Pfeilstöcker, T Nösslinger, P Valent, C Fonatsch, M Lübbert, D Haase, C Steidl, O Krieger, R Stauder, A A N Giagounidis, C Strupp, A Kündgen, T Mueller, R Haas, N Gattermann, C Aul

ABSTRACT

The international prognostic scoring system (IPSS) is considered the gold standard for risk assessment in primary myelodysplastic syndromes (MDS). This score includes several prognostic factors except serum lactate dehydrogenase (LDH). We evaluated the prognostic power of LDH as an additional variable in IPSS-based risk assessment. For this purpose, a total of 892 patients with primary MDS registered by the Austrian–German cooperative MDS study group was analyzed retrospectively. Multivariate analysis confirmed the value of established parameters such as medullary blasts, karyotype and peripheral cell counts and showed that elevated LDH was associated with decreased overall survival (P<0.00005) and increased risk of AML development (P<0.00005), independent of the system used to classify MDS (FAB or WHO). Moreover, elevated LDH was found to be a significant predictor of poor survival within each IPSS risk group and within each FAB group except RAEB-T. To exploit these results for refined prognostication, each IPSS risk group was split into two separate categories (A=normal LDH vs B=elevated LDH). Using this LDH-assisted approach, it was possible to identify MDS patients with unfavorable prognosis within the low and intermediate IPSS risk groups. We propose that the IPSS+LDH score should improve clinical decision-making and facilitate proper risk stratification in clinical trials. More... »

PAGES

2223-2231

Identifiers

URI

http://scigraph.springernature.com/pub.10.1038/sj.leu.2403963

DOI

http://dx.doi.org/10.1038/sj.leu.2403963

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1000607804

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/16193087


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27 schema:description The international prognostic scoring system (IPSS) is considered the gold standard for risk assessment in primary myelodysplastic syndromes (MDS). This score includes several prognostic factors except serum lactate dehydrogenase (LDH). We evaluated the prognostic power of LDH as an additional variable in IPSS-based risk assessment. For this purpose, a total of 892 patients with primary MDS registered by the Austrian–German cooperative MDS study group was analyzed retrospectively. Multivariate analysis confirmed the value of established parameters such as medullary blasts, karyotype and peripheral cell counts and showed that elevated LDH was associated with decreased overall survival (P<0.00005) and increased risk of AML development (P<0.00005), independent of the system used to classify MDS (FAB or WHO). Moreover, elevated LDH was found to be a significant predictor of poor survival within each IPSS risk group and within each FAB group except RAEB-T. To exploit these results for refined prognostication, each IPSS risk group was split into two separate categories (A=normal LDH vs B=elevated LDH). Using this LDH-assisted approach, it was possible to identify MDS patients with unfavorable prognosis within the low and intermediate IPSS risk groups. We propose that the IPSS+LDH score should improve clinical decision-making and facilitate proper risk stratification in clinical trials.
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34 FAB group
35 IPSS risk group
36 International Prognostic Scoring System
37 MDS patients
38 RAEB
39 additional prognostic variables
40 additional variables
41 analysis
42 approach
43 assessment
44 blasts
45 categories
46 cell count
47 clinical trials
48 count
49 dehydrogenase
50 development
51 elevated lactate dehydrogenase
52 factors
53 gold standard
54 group
55 karyotype
56 lactate dehydrogenase
57 medullary blasts
58 multivariate analysis
59 myelodysplastic syndrome
60 overall survival
61 parameters
62 patients
63 peripheral cell counts
64 poor survival
65 power
66 predictors
67 primary myelodysplastic syndromes
68 prognosis
69 prognostic factors
70 prognostic power
71 prognostic scoring system
72 prognostic variables
73 prognostication
74 proper risk stratification
75 purpose
76 refined prognostication
77 refinement
78 results
79 risk
80 risk assessment
81 risk groups
82 risk stratification
83 scores
84 scoring system
85 separate category
86 serum lactate dehydrogenase
87 significant predictors
88 standards
89 stratification
90 study group
91 survival
92 syndrome
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94 total
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