Papageorgiou Sotirios G, Kotsianidis Ioannis, Bouchla Anthi, Symeonidis Argyris, Galanopoulos Athanasios, Viniou Nora-Athina, Hatzimichael Eleftheria, Vassilakopoulos Theodoros P, Gogos Dimitrios, Megalakaki Aikaterini, Zikos Panagiotis, Diamantopoulos Panagiotis, Kourakli Alexandra, Giannoulia Panagiota, Papoutselis Menelaos, Poulakidas Elias, Arapaki Maria, Vardi Anna, Anagnostopoulos Achilles, Mparmparousi Despoina, Papaioannou Maria, Bouronikou Eleni, Dimou Maria, Papadaki Helen, Panayiotidis Panayiotis, Pappa Vasiliki
Consultant of Hematology, Second Department of Internal Medicine and Research Unit, University General Hospital "Attikon", 1 Rimini St., Haidari, Athens, 12462, Greece.
Department of Hematology, Democritus University of Thrace Medical School, University Hospital of Alexandroupolis, Alexandroupolis, Greece.
Ther Adv Hematol. 2020 Dec 8;11:2040620720966121. doi: 10.1177/2040620720966121. eCollection 2020.
BACKGROUND: 5-azacytidine (5-AZA) improves survival of patients with higher-risk myelodysplastic syndromes (MDSs) and oligoblastic acute myeloid leukemia (AML); however, predictive factors for response and outcome have not been consistently studied. METHODS: This study of the Hellenic MDS Study Group included 687 consecutive patients with higher-risk MDS and oligoblastic AML treated with 5-AZA. RESULTS: The International Prognostic Scoring System (IPSS) revised version (IPSS-R), Eastern Cooperative Oncology Group Performance Status (ECOG PS) (0 or 1 ⩾2) and baseline serum ferritin (SF) levels > 520 ng/ml were shown to independently predict response to 5-AZA. In the survival analysis, the IPSS and IPSS-R risk classification systems along with the ECOG PS and SF levels > 520 ng/ml proved to be independent prognosticators for overall survival (OS), as well as for leukemia-free survival (LFS). Next, we built new multivariate models for OS and LFS, incorporating only ECOG PS and SF levels besides IPSS or IPSS-R risk classification systems. Thereby, the new modified IPSS and IPSS-R risk classification systems (H-PSS, H-PSS-R) could each discriminate a low, an intermediate and a high-risk patient group regarding OS and LFS. The H-PSS and H-PSS-R proved to be better predictors of OS than their previous counterparts as well as the French prognostic score, while the most powerful OS predictor was the new, H-PSS-R system. CONCLUSIONS: ECOG PS and SF levels > 520 ng/ml independently predict response to 5-AZA, OS and LFS. Their incorporation in the IPSS and IPSS-R scores enhances these scores' predictive power in 5-AZA-treated higher-risk MDS and oligoblastic AML patients.
背景：5-氮杂胞苷（5-AZA）可提高高危骨髓增生异常综合征（MDS）和少细胞性急性髓系白血病（AML）患者的生存率；然而，关于反应和预后的预测因素尚未得到一致研究。 方法：希腊MDS研究组的这项研究纳入了687例连续接受5-AZA治疗的高危MDS和少细胞性AML患者。 结果：国际预后评分系统（IPSS）修订版（IPSS-R）、东部肿瘤协作组体能状态（ECOG PS）（0或1⩾2）以及基线血清铁蛋白（SF）水平>520 ng/ml被证明可独立预测对5-AZA的反应。在生存分析中，IPSS和IPSS-R风险分类系统以及ECOG PS和SF水平>520 ng/ml被证明是总生存期（OS）以及无白血病生存期（LFS）的独立预后因素。接下来，我们构建了新的OS和LFS多变量模型，除了IPSS或IPSS-R风险分类系统外，仅纳入ECOG PS和SF水平。由此，新的改良IPSS和IPSS-R风险分类系统（H-PSS、H-PSS-R）在OS和LFS方面均可区分低、中、高危患者组。H-PSS和H-PSS-R被证明比其先前版本以及法国预后评分更能预测OS，而最强的OS预测指标是新的H-PSS-R系统。 结论：ECOG PS和SF水平>520 ng/ml可独立预测对5-AZA的反应、OS和LFS。将它们纳入IPSS和IPSS-R评分可增强这些评分对接受5-AZA治疗的高危MDS和少细胞性AML患者的预测能力。
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