Tweets

Powered by Squarespace
« Myelodysplastic Syndrome - Treatment | Myelodysplastic Syndrome - Diagnosis and Presentation »

Myelodysplastic Syndrome - Classification and Prognostication

Simple prognostic figures by the FAB classificationBefore treatment options can be discussed, it is very important to talk to the patients at length about what the diagnosis mean to them. In a nutshell, MDS carries a long-term risk of terminal transformation into acute leukaemia, which will be resistant to chemotherapy and even bone marrow transplant. Currently, conventional treatment has minimal bearing in terms of delaying the inevitability. Treatment may also give serious side-effect which in itself may shorten the patients’ survival. The important thing here is to maximise the quality of life in patients where the prognosis is poor. The only chance for long-term cure would be with bone marrow transplant which should be offered to suitable candidates. Once patient is identified into these prognostic group, the prognosis then becomes clearer, and it will be easier to plan long-term treatment.

This chapter will concentrate just on the prognostication process, and I will leave the treatment in a later entry.

Ever since the days of the FAB classifications for MDS, it has become very clear that the different subgroup has different outcome. Looking at historical data, an attempt was made at putting figures into this fact, as highlighted in the chart up top. This may suggest that the further down the list we go, the more advance the disease is, but in real life, that may not be the case. We have seen patient with CMML living longer than RAEB. This figures just serve as a simple guide.

With the introduction of the WHO classification, further calculations were made to look at median survival - the time it takes for 50% of patients to pass away from time of diagnosis - and the rate of transformation into acute leukaemia. The IPSS (International Prognosis Scoring System) classify the outcome in patients with MDS based on 4 factors - the first 3; the amount of blast percentage in the bone marrow, cytogenetics studies (study of chromosome in stem cells) and the number of lineage of blood cells affected; was scored to give the 4 risk groups - low, intermediate-1, intermediate-2 and high. The risk group was then tabulated against a fourth factor, age, to determine the median survival and risk of transformation.

A score was determine from looking at the above 3 factors, bone marrow blast percentage, karyotypes and cytopenias.The number was then used to assign the patient into the appropriate risk groupsThe IPSS is useful in a couple of senses, the risk group can form the base for discussion of treatment options, and the score can also be used for calculation of overall survival.

The outcome risk as tabulated with patients age in terms of survival in yearsOnce the patient risk group was identified, a more in depth discussion about treatment can be made. Again, I can not emphasise more the importance of bone marrow assessment in patients with MDS. One can only obtain cytogenetics study from the marrow, as well as the need to calculate the percentage of marrow blast cell to come up with the IPSS score. There are also alternative scoring system such as the WPSS, which is beyond the scope for this site.

PrintView Printer Friendly Version

EmailEmail Article to Friend

References (19)

References allow you to track sources for this article, as well as articles that were written in response to this article.
  • Response
    Myelodysplastic Syndrome - Classification and Prognostication - Entries - Haematology at SDMC
  • Response
    Myelodysplastic Syndrome - Classification and Prognostication - Entries - Haematology at SDMC
  • Response
    Myelodysplastic Syndrome - Classification and Prognostication - Entries - Haematology at SDMC
  • Response
    Myelodysplastic Syndrome - Classification and Prognostication - Entries - Haematology at SDMC
  • Response
    Myelodysplastic Syndrome - Classification and Prognostication - Entries - Haematology at SDMC
  • Response
    Myelodysplastic Syndrome - Classification and Prognostication - Entries - Haematology at SDMC
  • Response
    Myelodysplastic Syndrome - Classification and Prognostication - Entries - Haematology at SDMC
  • Response
    Response: chromatography
    Myelodysplastic Syndrome - Classification and Prognostication - Entries - Haematology at SDMC
  • Response
    Response: lab furniture
    Myelodysplastic Syndrome - Classification and Prognostication - Entries - Haematology at SDMC
  • Response
    Response: furniture for labs
    Myelodysplastic Syndrome - Classification and Prognostication - Entries - Haematology at SDMC
  • Response
    Response: houzz
    Myelodysplastic Syndrome - Classification and Prognostication - Entries - Haematology at SDMC
  • Response
    Myelodysplastic Syndrome - Classification and Prognostication - Entries - Haematology at SDMC
  • Response
    Response: home interior
    Myelodysplastic Syndrome - Classification and Prognostication - Entries - Haematology at SDMC
  • Response
    Response: dressing Table
    Myelodysplastic Syndrome - Classification and Prognostication - Entries - Haematology at SDMC
  • Response
    Myelodysplastic Syndrome - Classification and
  • Response
    Response: best fish finder
    Myelodysplastic Syndrome - Classification and
  • Response
    Response: best fish finder
    Myelodysplastic Syndrome - Classification and
  • Response
    Myelodysplastic Syndrome - Classification and
  • Response
    Myelodysplastic Syndrome - Classification and

Reader Comments

There are no comments for this journal entry. To create a new comment, use the form below.

PostPost a New Comment

Enter your information below to add a new comment.

My response is on my own website »
Author Email (optional):
Author URL (optional):
Post:
 
Some HTML allowed: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <code> <em> <i> <strike> <strong>