TY - JOUR
T1 - Mayo Alliance Prognostic Model for Myelodysplastic Syndromes
T2 - Integration of Genetic and Clinical Information
AU - Tefferi, Ayalew
AU - Gangat, Naseema
AU - Mudireddy, Mythri
AU - Lasho, Terra L.
AU - Finke, Christy
AU - Begna, Kebede H.
AU - Elliott, Michelle A.
AU - Al-Kali, Aref
AU - Litzow, Mark R.
AU - Hook, C. Christopher
AU - Wolanskyj, Alexandra P.
AU - Hogan, William J.
AU - Patnaik, Mrinal M.
AU - Pardanani, Animesh
AU - Zblewski, Darci L.
AU - He, Rong
AU - Viswanatha, David
AU - Hanson, Curtis A.
AU - Ketterling, Rhett P.
AU - Tang, Jih Luh
AU - Chou, Wen Chien
AU - Lin, Chien Chin
AU - Tsai, Cheng Hong
AU - Tien, Hwei Fang
AU - Hou, Hsin An
N1 - Publisher Copyright:
© 2018 Mayo Foundation for Medical Education and Research
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2018/10
Y1 - 2018/10
N2 - 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.
AB - 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.
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U2 - 10.1016/j.mayocp.2018.04.013
DO - 10.1016/j.mayocp.2018.04.013
M3 - Article
C2 - 29866419
AN - SCOPUS:85047819256
SN - 0025-6196
VL - 93
SP - 1363
EP - 1374
JO - Mayo Clinic Proceedings
JF - Mayo Clinic Proceedings
IS - 10
ER -