In myelodysplastic syndromes (MDSs), the evolution of risk for disease progression or death has not been systematically investigated despite being crucial for correct interpretation of prognostic risk scores. In a multicenter retrospective study, we described changes in risk over time, the consequences for basal prognostic scores, and their potential clinical implications. Major MDS prognostic risk scoring systems and their constituent individual predictors were analyzed in 7212 primary untreated MDS patients from the International Working Group for Prognosis in MDS database. Changes in risk of mortality and of leukemic transformation over time from diagnosis were described. Hazards regarding mortality and acute myeloid leukemia transformation diminished over time from diagnosis in higher-risk MDS patients, whereas they remained stable in lower-risk patients. After approximately 3.5 years, hazards in the separate risk groups became similar and were essentially equivalent after 5 years. This fact led to loss of prognostic power of different scoring systems considered, which was more pronounced for survival. Inclusion of age resulted in increased initial prognostic power for survival and less attenuation in hazards. If needed for practicability in clinical management, the differing development of risks suggested a reasonable division into lower- and higher-risk MDS based on the IPSS-R at a cutoff of 3.5 points. Our data regarding time-dependent performance of prognostic scores reflect the disparate change of risks in MDS subpopulations. Lower-risk patients at diagnosis remain lower risk whereas initially high-risk patients demonstrate decreasing risk over time. This change of risk should be considered in clinical decision making.

Antonio e Biagio e Cesare Arrigo Hospital Alessandria Italy;

Cleveland Clinic Cleveland OH;

Department of Pathology University of New Mexico Albuquerque NM;

Division of Hematology Medical University of Vienna and L Boltzmann Cluster Oncology Vienna Austria;

Division of Hematology Medical University of Vienna Vienna Austria;

Elisabethinen Hospital Linz Austria;

Federal University of Ceara Fortaleza Brazil;

Fondazione Istituti di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo and University of Pavia Pavia Italy;

Georg August Universität Göttingen Germany;

Hanusch Hospital and L Boltzmann Cluster Oncology Vienna Austria;

Heinrich Heine University Hospital Düsseldorf Germany;

Hopital Avicenne Assistance Publique Hopitaux de Paris University of Paris XIII Bobigny France;

Hopital Cochin AP HP University of Paris 5 Paris France;

Hospital Universitario La Fe Valencia Spain;

Hospital Universitario Vall d'Hebron Barcelona Spain;

Institut de Recerca contra la Leucèmia Josep Carreras Barcelona Spain;

Institute of Hematology and Blood Transfusion Praha Czech Republic;

James P Wilmot Cancer Center University of Rochester Medical Center Rochester NY;

L Boltzmann Institute for Leukemia Research Vienna Austria;

Medical University of Vienna Vienna Austria;

Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan;

St James's University Hospital Leeds United Kingdom;

Stanford Cancer Institute Stanford CA

The University of Texas MD Anderson Cancer Center Houston TX;

University Hospital of Innsbruck Innsbruck Austria;

University of Chicago Comprehensive Cancer Research Center Chicago IL;

University of Dundee Dundee United Kingdom;

University of Freiburg Medical Center Freiburg Germany;

Vrije Universiteit Medical Center Amsterdam The Netherlands; and

Blood. 2016 Aug 18;128(7):885-6. doi: 10.1182/blood-2016-07-724930. PubMed

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