Mayo Alliance Prognostic Model for Myelodysplastic Syndromes: Integration of Genetic and Clinical Information

Ayalew Tefferi, Naseema Gangat, Mythri Mudireddy, Terra L. Lasho, Christy Finke, Kebede H. Begna, Michelle A. Elliott, Aref Al-Kali, Mark R. Litzow, C. Christopher Hook, Alexandra P. Wolanskyj, William J. Hogan, Mrinal M. Patnaik, Animesh Pardanani, Darci L. Zblewski, Rong He, David Viswanatha, Curtis A. Hanson, Rhett P. Ketterling, Jih Luh TangWen Chien Chou, Chien Chin Lin, Cheng Hong Tsai, Hwei Fang Tien, Hsin An Hou

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Objective: To develop a new risk model for primary myelodysplastic syndromes (MDS) that integrates information on mutations, karyotype, and clinical variables. Patients and Methods: Patients with World Health Organization–defined primary MDS seen at Mayo Clinic (MC) from December 28, 1994, through December 19, 2017, constituted the core study group. The National Taiwan University Hospital (NTUH) provided the validation cohort. Model performance, compared with the revised International Prognostic Scoring System, was assessed by Akaike information criterion and area under the curve estimates. Results: The study group consisted of 685 molecularly annotated patients from MC (357) and NTUH (328). Multivariate analysis of the MC cohort identified monosomal karyotype (hazard ratio [HR], 5.2; 95% CI, 3.1-8.6), “non-MK abnormalities other than single/double del(5q)” (HR, 1.8; 95% CI, 1.3-2.6), RUNX1 (HR, 2.0; 95% CI, 1.2-3.1) and ASXL1 (HR, 1.7; 95% CI, 1.2-2.3) mutations, absence of SF3B1 mutations (HR, 1.6; 95% CI, 1.1-2.4), age greater than 70 years (HR, 2.2; 95% CI, 1.6-3.1), hemoglobin level less than 8 g/dL in women or less than 9 g/dL in men (HR, 2.3; 95% CI, 1.7-3.1), platelet count less than 75 × 109/L (HR, 1.5; 95% CI, 1.1-2.1), and 10% or more bone marrow blasts (HR, 1.7; 95% CI, 1.1-2.8) as predictors of inferior overall survival. Based on HR-weighted risk scores, a 4-tiered Mayo alliance prognostic model for MDS was devised: low (89 patients), intermediate-1 (104), intermediate-2 (95), and high (69); respective median survivals (5-year overall survival rates) were 85 (73%), 42 (34%), 22 (7%), and 9 months (0%). The Mayo alliance model was subsequently validated by using the external NTUH cohort and, compared with the revised International Prognostic Scoring System, displayed favorable Akaike information criterion (1865 vs 1943) and area under the curve (0.87 vs 0.76) values. Conclusion: We propose a simple and contemporary risk model for MDS that is based on a limited set of genetic and clinical variables.

Original languageEnglish (US)
Pages (from-to)1363-1374
Number of pages12
JournalMayo Clinic proceedings
Volume93
Issue number10
DOIs
StatePublished - Oct 2018

ASJC Scopus subject areas

  • Medicine(all)

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