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Therapy-Related Myelodysplastic Syndrome
Morphologic Subclassification May Not Be Clinically Relevant

Zeba N. Singh MD, Dezheng Huo PhD, John Anastasi MD, Sonali M. Smith MD, Theodore Karrison PhD, Michelle M. Le Beau PhD, Richard A. Larson MD, James W. Vardiman MD
DOI: http://dx.doi.org/10.1309/NQ3PMV4U8YV39JWJ 197-205 First published online: 1 February 2007

Abstract

In practice, cases of therapy-related myelodysplastic syndrome (t-MDS) are often classified according to morphologic schemes used for de novo MDS. However, there are few data addressing the appropriateness of such classification. We studied 155 patients with therapy-related acute myeloid leukemia (t-AML)/t-MDS to determine whether subclassification by the World Health Organization (WHO) criteria for de novo MDS provides prognostic information in t-MDS. In addition, we assessed whether cytogenetic stratification by the International Prognostic Scoring System (IPSS) guidelines or karyotypic complexity was prognostically important. We found no differences in median survival times among patients classified into the different WHO subgroup of MDS or according to their bone marrow blast percentage; our results indicate a uniformly poor outcome in t-MDS regardless of morphologic classification. However, significant survival differences correlated with cytogenetic stratification according to IPSS guidelines and/or karyotypic complexity. We found only a borderline difference in median survival of patients with an initial t-MDS diagnosis compared with patients with an initial t-AML diagnosis.

Key Words:
  • Therapy-related leukemia
  • Therapy-related myelodysplasia
  • World Health Organization classification