Division of Hematologic Malignancies, Sidney Kimmel Cancer Center at Johns Hopkins, Baltimore, MD.
Hematology Am Soc Hematol Educ Program. 2021 Dec 10;2021(1):428-434. doi: 10.1182/hematology.2021000277.
Risk stratification is crucial to the appropriate management of most cancers, but in patients with myelodysplastic syndromes (MDS), for whom expected survival can vary from a few months to more than a decade, accurate disease prognostication is especially important. Currently, patients with MDS are often grouped into higher-risk (HR) vs lower-risk (LR) disease using clinical prognostic scoring systems, but these systems have limitations. Factors such as molecular genetic information or disease characteristics not captured in the International Prognostic Scoring System-Revised (IPSS-R) can alter risk stratification and identify a subset of patients with LR-MDS who actually behave more like those with HR-MDS. This review describes the current identification and management of patients with LR-MDS whose condition is likely to behave in a less favorable manner than predicted by the IPSS-R.
风险分层对于大多数癌症的适当管理至关重要，但对于骨髓增生异常综合征（MDS）患者，由于其预期生存时间可能从数月到十年以上不等，因此准确预测疾病预后尤为重要。目前，MDS 患者通常使用临床预后评分系统分为高危（HR）和低危（LR）疾病，但这些系统存在局限性。一些因素，如国际预后评分系统修订版（IPSS-R）中未捕获的分子遗传学信息或疾病特征，可能会改变风险分层，并确定一部分 LR-MDS 患者的行为实际上更类似于 HR-MDS 患者。本文综述了目前对 LR-MDS 患者的识别和管理，这些患者的病情表现可能不如 IPSS-R 预测的那样有利。
