Early platelet count kinetics has prognostic value in lower-risk myelodysplastic syndromes

Raphael Itzykson; Simon Crouch; Erica Travaglino; Argiris Symeonidis; Eva Hellström-Lindberg; Guillermo Sanz; Jaroslav Čermák; Reinhard Stauder; Chiara Elena; Ulrich Germing; Moshe Mittelman; Saskia Langemeijer; Krzysztof Mądry; Aurelia Tatic; Mette Skov Holm; Antonio Medina Almeida; Aleksandar Savic; Njetočka Gredelj Šimec; Elisa Luño; Dominic Culligan; Agnes Guerci-Bresler; Luca Malcovati; Corine van Marrewijk; David Bowen; Theo de Witte; Pierre Fenaux; European MDS Registry members; Alexandra Gwen Smith

doi:10.1182/bloodadvances.2018020495

Early platelet count kinetics has prognostic value in lower-risk myelodysplastic syndromes

Raphael Itzykson, Simon Crouch, Erica Travaglino, Argiris Symeonidis, Eva Hellström-Lindberg, Guillermo Sanz, Jaroslav Čermák, Reinhard Stauder, Chiara Elena, Ulrich Germing, Moshe Mittelman, Saskia Langemeijer, Krzysztof Mądry, Aurelia Tatic, Mette Skov Holm, Antonio Medina Almeida, Aleksandar Savic, Njetočka Gredelj Šimec, Elisa Luño, Dominic CulliganAgnes Guerci-Bresler, Luca Malcovati, Corine van Marrewijk, David Bowen, Theo de Witte, Pierre Fenaux, European MDS Registry members, Alexandra Gwen Smith

Health Sciences

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Abstract

Prognosis of lower-risk (International Prognostic Scoring System [IPSS] low/intermediate-1) myelodysplastic syndrome (MDS) is heterogeneous and relies on steady-state assessment of cytopenias. We analyzed relative drops in neutrophil and platelet counts during the first 6 months of follow-up of lower-risk MDS patients. We performed a landmark analysis of overall survival (OS) of lower-risk MDS patients prospectively included in the European LeukaemiaNet MDS registry having a visit at 6 ± 1 month from inclusion to assess the prognostic relevance of relative drops in neutrophils and platelets, defined as (count at landmark - count at inclusion)/count at inclusion. Of 2102 patients, 807 were eligible for the stringent 6-month landmark analysis. Median age was 73 years. Revised IPSS was very low, low, and intermediate/higher in 26%, 43%, and 31% of patients, respectively. A relative drop in platelets >25% at landmark predicted shorter OS (5-year OS, 21.9% vs 48.6% with platelet drop ≤25%, P < 10-4), regardless of baseline IPSS-revised or absolute platelet counts. Relative neutrophil drop >25% had no significant impact on OS. We built a classifier based on red blood cell transfusion dependence (RBC-TD) and relative platelet drop >25% at landmark. Patients with none (62%), either (27%), or both criteria (11%) had 5-year OS of 53.3%, 32.7%, and 9.0%, respectively (P < 10-4). This classifier was validated in an independent cohort of 335 patients. Combining relative platelet drop >25% and RBC-TD at 6 months from diagnosis provides an inexpensive and noninvasive way to predict outcome in lower-risk MDS. This study was registered at www.clinicaltrials.gov as #NCT00600860.

Original language	English
Pages (from-to)	2079-2089
Number of pages	11
Journal	Blood Advances
Volume	2
Issue number	16
DOIs	https://doi.org/10.1182/bloodadvances.2018020495
Publication status	Published - 28 Aug 2018

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10.1182/bloodadvances.2018020495

Early platelet count kinetics has prognostic value in lower-risk
© 2018 by The American Society of Hematology. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details
Final published version, 1.06 MBLicence: Unspecified

Simon Crouch
- simon.crouchyork.acuk
- Health Sciences - Senior Research Fellow
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Itzykson, R., Crouch, S., Travaglino, E., Symeonidis, A., Hellström-Lindberg, E., Sanz, G., Čermák, J., Stauder, R., Elena, C., Germing, U., Mittelman, M., Langemeijer, S., Mądry, K., Tatic, A., Holm, M. S., Almeida, A. M., Savic, A., Šimec, N. G., Luño, E., ... Smith, A. G. (2018). Early platelet count kinetics has prognostic value in lower-risk myelodysplastic syndromes. Blood Advances, 2(16), 2079-2089. https://doi.org/10.1182/bloodadvances.2018020495

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title = "Early platelet count kinetics has prognostic value in lower-risk myelodysplastic syndromes",

abstract = "Prognosis of lower-risk (International Prognostic Scoring System [IPSS] low/intermediate-1) myelodysplastic syndrome (MDS) is heterogeneous and relies on steady-state assessment of cytopenias. We analyzed relative drops in neutrophil and platelet counts during the first 6 months of follow-up of lower-risk MDS patients. We performed a landmark analysis of overall survival (OS) of lower-risk MDS patients prospectively included in the European LeukaemiaNet MDS registry having a visit at 6 ± 1 month from inclusion to assess the prognostic relevance of relative drops in neutrophils and platelets, defined as (count at landmark - count at inclusion)/count at inclusion. Of 2102 patients, 807 were eligible for the stringent 6-month landmark analysis. Median age was 73 years. Revised IPSS was very low, low, and intermediate/higher in 26%, 43%, and 31% of patients, respectively. A relative drop in platelets >25% at landmark predicted shorter OS (5-year OS, 21.9% vs 48.6% with platelet drop ≤25%, P < 10-4), regardless of baseline IPSS-revised or absolute platelet counts. Relative neutrophil drop >25% had no significant impact on OS. We built a classifier based on red blood cell transfusion dependence (RBC-TD) and relative platelet drop >25% at landmark. Patients with none (62%), either (27%), or both criteria (11%) had 5-year OS of 53.3%, 32.7%, and 9.0%, respectively (P < 10-4). This classifier was validated in an independent cohort of 335 patients. Combining relative platelet drop >25% and RBC-TD at 6 months from diagnosis provides an inexpensive and noninvasive way to predict outcome in lower-risk MDS. This study was registered at www.clinicaltrials.gov as #NCT00600860.",

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author = "Raphael Itzykson and Simon Crouch and Erica Travaglino and Argiris Symeonidis and Eva Hellstr{\"o}m-Lindberg and Guillermo Sanz and Jaroslav {\v C}erm{\'a}k and Reinhard Stauder and Chiara Elena and Ulrich Germing and Moshe Mittelman and Saskia Langemeijer and Krzysztof M{\c a}dry and Aurelia Tatic and Holm, {Mette Skov} and Almeida, {Antonio Medina} and Aleksandar Savic and {\v S}imec, {Njeto{\v c}ka Gredelj} and Elisa Lu{\~n}o and Dominic Culligan and Agnes Guerci-Bresler and Luca Malcovati and {van Marrewijk}, Corine and David Bowen and {de Witte}, Theo and Pierre Fenaux and {European MDS Registry members} and Smith, {Alexandra Gwen}",

note = "{\textcopyright} 2018 by The American Society of Hematology. Uploaded in accordance with the publisher{\textquoteright}s self-archiving policy. Further copying may not be permitted; contact the publisher for details ",

year = "2018",

month = aug,

day = "28",

doi = "10.1182/bloodadvances.2018020495",

language = "English",

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Itzykson, R, Crouch, S, Travaglino, E, Symeonidis, A, Hellström-Lindberg, E, Sanz, G, Čermák, J, Stauder, R, Elena, C, Germing, U, Mittelman, M, Langemeijer, S, Mądry, K, Tatic, A, Holm, MS, Almeida, AM, Savic, A, Šimec, NG, Luño, E, Culligan, D, Guerci-Bresler, A, Malcovati, L, van Marrewijk, C, Bowen, D, de Witte, T, Fenaux, P, European MDS Registry members & Smith, AG 2018, 'Early platelet count kinetics has prognostic value in lower-risk myelodysplastic syndromes', Blood Advances, vol. 2, no. 16, pp. 2079-2089. https://doi.org/10.1182/bloodadvances.2018020495

TY - JOUR

T1 - Early platelet count kinetics has prognostic value in lower-risk myelodysplastic syndromes

AU - Itzykson, Raphael

AU - Crouch, Simon

AU - Travaglino, Erica

AU - Symeonidis, Argiris

AU - Hellström-Lindberg, Eva

AU - Sanz, Guillermo

AU - Čermák, Jaroslav

AU - Stauder, Reinhard

AU - Elena, Chiara

AU - Germing, Ulrich

AU - Mittelman, Moshe

AU - Langemeijer, Saskia

AU - Mądry, Krzysztof

AU - Tatic, Aurelia

AU - Holm, Mette Skov

AU - Almeida, Antonio Medina

AU - Savic, Aleksandar

AU - Šimec, Njetočka Gredelj

AU - Luño, Elisa

AU - Culligan, Dominic

AU - Guerci-Bresler, Agnes

AU - Malcovati, Luca

AU - van Marrewijk, Corine

AU - Bowen, David

AU - de Witte, Theo

AU - Fenaux, Pierre

AU - European MDS Registry members

AU - Smith, Alexandra Gwen

PY - 2018/8/28

Y1 - 2018/8/28

N2 - Prognosis of lower-risk (International Prognostic Scoring System [IPSS] low/intermediate-1) myelodysplastic syndrome (MDS) is heterogeneous and relies on steady-state assessment of cytopenias. We analyzed relative drops in neutrophil and platelet counts during the first 6 months of follow-up of lower-risk MDS patients. We performed a landmark analysis of overall survival (OS) of lower-risk MDS patients prospectively included in the European LeukaemiaNet MDS registry having a visit at 6 ± 1 month from inclusion to assess the prognostic relevance of relative drops in neutrophils and platelets, defined as (count at landmark - count at inclusion)/count at inclusion. Of 2102 patients, 807 were eligible for the stringent 6-month landmark analysis. Median age was 73 years. Revised IPSS was very low, low, and intermediate/higher in 26%, 43%, and 31% of patients, respectively. A relative drop in platelets >25% at landmark predicted shorter OS (5-year OS, 21.9% vs 48.6% with platelet drop ≤25%, P < 10-4), regardless of baseline IPSS-revised or absolute platelet counts. Relative neutrophil drop >25% had no significant impact on OS. We built a classifier based on red blood cell transfusion dependence (RBC-TD) and relative platelet drop >25% at landmark. Patients with none (62%), either (27%), or both criteria (11%) had 5-year OS of 53.3%, 32.7%, and 9.0%, respectively (P < 10-4). This classifier was validated in an independent cohort of 335 patients. Combining relative platelet drop >25% and RBC-TD at 6 months from diagnosis provides an inexpensive and noninvasive way to predict outcome in lower-risk MDS. This study was registered at www.clinicaltrials.gov as #NCT00600860.

AB - Prognosis of lower-risk (International Prognostic Scoring System [IPSS] low/intermediate-1) myelodysplastic syndrome (MDS) is heterogeneous and relies on steady-state assessment of cytopenias. We analyzed relative drops in neutrophil and platelet counts during the first 6 months of follow-up of lower-risk MDS patients. We performed a landmark analysis of overall survival (OS) of lower-risk MDS patients prospectively included in the European LeukaemiaNet MDS registry having a visit at 6 ± 1 month from inclusion to assess the prognostic relevance of relative drops in neutrophils and platelets, defined as (count at landmark - count at inclusion)/count at inclusion. Of 2102 patients, 807 were eligible for the stringent 6-month landmark analysis. Median age was 73 years. Revised IPSS was very low, low, and intermediate/higher in 26%, 43%, and 31% of patients, respectively. A relative drop in platelets >25% at landmark predicted shorter OS (5-year OS, 21.9% vs 48.6% with platelet drop ≤25%, P < 10-4), regardless of baseline IPSS-revised or absolute platelet counts. Relative neutrophil drop >25% had no significant impact on OS. We built a classifier based on red blood cell transfusion dependence (RBC-TD) and relative platelet drop >25% at landmark. Patients with none (62%), either (27%), or both criteria (11%) had 5-year OS of 53.3%, 32.7%, and 9.0%, respectively (P < 10-4). This classifier was validated in an independent cohort of 335 patients. Combining relative platelet drop >25% and RBC-TD at 6 months from diagnosis provides an inexpensive and noninvasive way to predict outcome in lower-risk MDS. This study was registered at www.clinicaltrials.gov as #NCT00600860.

KW - Journal Article

U2 - 10.1182/bloodadvances.2018020495

DO - 10.1182/bloodadvances.2018020495

M3 - Article

C2 - 30126931

SN - 2473-9529

VL - 2

SP - 2079

EP - 2089

JO - Blood Advances

JF - Blood Advances

IS - 16

ER -

Early platelet count kinetics has prognostic value in lower-risk myelodysplastic syndromes

Abstract

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Simon Crouch

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