Dynamic assessment of RBC-Transfusion Dependency Improves the Prognostic Value of the Revised-IPSS in MDS Patients

Devendra K. Hiwase, Deepak Singhal, Corinna Strupp, Rakchha Chhetri, Monika M. Kutyna, L. Amilia Wee, Peter B. Harrison, Shriram V. Nath, Nicholas Wickham, Chi-Hung Hui, James X. Gray, Peter Bardy, David M. Ross, Ian D. Lewis, John Reynolds, L. Bik To, Ulrich Germing

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25 Citations (Scopus)


RBC-transfusion dependency (RBC-TD) is an independent prognostic factor for poor overall survival (OS) in the WHO classification-based prognostic scoring system (WPSS) for MDS patients. However, WPSS did not include cytopenia, whereas revised International Prognostic Scoring System (IPSS-R) did not include RBC-TD. Thus, neither of these prognostic scoring systems incorporates both cytopenia and RBC-TD. We aimed to test whether RBC-TD adds prognostic value to the IPSS-R. We analyzed MDS patients not treated with disease-modifying therapy, and enrolled in SA-MDS Registry (derivation cohort; n = 295) and Dusseldorf registry (Germany; validation cohort; n = 113) using time-dependent Cox proportional regression and serial landmark analyses. In the derivation cohort, RBC-TD patients had inferior OS compared to RBC transfusion-independent (RBC-TI) patients (P < 0.0001) at 6- (18 vs. 64 months), 12- (24 vs. 71 months), and 24-months (40 vs. 87 months). In a Cox proportional regression analysis, RBC-TD was an independent adverse prognostic marker in addition to age, sex, and IPSS-R variables (P < 0.0001). A prognostic index (PI) was derived using these Cox-proportional regression model variables. In the validation cohort, this PI classified patients into four prognostic groups with significantly different OS (P < 0.001) as in the derivation cohort. In conclusion, multivariate analysis by Cox proportional hazards regression and serial landmark analyses clearly demonstrates that development of RBC-TD at any time during the course of MDS is associated with poor OS, independent of IPSS-R. This study demonstrates that dynamic assessment of RBC-TD provides additional prognostic value to IPSS-R and should be included in treatment decision algorithms for MDS patients.
Original languageEnglish
Pages (from-to)508-514
Number of pages7
JournalAmerican Journal of Hematology
Issue number6
Publication statusPublished - Jun 2017

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