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

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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 languageEnglish
Pages (from-to)2079-2089
Number of pages11
JournalBlood Advances
Issue number16
Publication statusPublished - 28 Aug 2018

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© 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


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