Clinical features of myelodysplastic syndromes (MDS) could be influenced by many factors, such as disease intrinsic factors (e.g., morphologic, cytogenetic, molecular), extrinsic factors (e.g, management, environment), and ethnicity. Several previous studies have suggested such differences between Asian and European/USA countries. In this study, to elucidate potential differences in primary untreated MDS between Japanese (JPN) and Caucasians (CAUC), we analyzed the data from a large international database collected by the International Working Group for Prognosis of MDS (300 and 5838 patients, respectively). JPN MDS were significantly younger with more severe cytopenias, and cytogenetic differences: less del(5q) and more +1/+1q, -1/del(1p), der(1;7), -9/del(9q), del(16q), and del(20q). Although differences in time to acute myeloid leukemia transformation did not occur, a significantly better survival in JPN was demonstrated, even after the adjustment for age and FAB subtypes, especially in lower, but not in higher prognostic risk categories. Certain clinical factors (cytopenias, blast percentage, cytogenetic risk) had different impact on survival and time to transformation to leukemia between the two groups. Although possible confounding events (e.g., environment, diet, and access to care) could not be excluded, our results indicated the existence of clinically relevant ethnic differences regarding survival in MDS between JPN and CAUC patients. The good performance of the IPSS-R in both CAUC and JP patients underlines that its common risk model is adequate for CAUC and JP.

Cleveland Clinic Cleveland OH United States

Department of Internal Medicine 1 Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology Medical University of Vienna Austria

Department of Pathology University of New Mexico Albuquerque NM United States

Elisabethinen Hospital Linz Austria

Federal University of Ceara Fortaleza Brazil

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

Hanusch Hospital and Ludwig Boltzmann Cluster Oncology Vienna Austria

Heinrich Heine University Hospital Dusseldorf 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 United States

L Boltzmann Institute for Leukemia Research Vienna Austria

MDS Unit Ematologia AOU Careggi Università degli Studi di Firenze Firenze Italy

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 United States

The University of Texas MD Anderson Cancer Center Houston TX United States

University Hospital of Innsbruck Innsbruck Austria

University Medical Center Clinics of Haematology and Medical Oncology Göttingen Germany

University of Chicago Comprehensive Cancer Research Center Chicago IL United States

University of Dundee Dundee United Kingdom

University of Freiburg Medical Center Faculty of Medicine Freiburg Germany

VU University Medical Center Cancer Center Amsterdam Amsterdam The Netherlands

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