Early platelet count kinetics has prognostic value in lower-risk myelodysplastic syndromes

• Published in: Blood advances Vol. 2; no. 16; pp. 2079 - 2089
• Main Authors: Itzykson, Raphael, Crouch, Simon, Travaglino, Erica, Smith, Alex, Symeonidis, Argiris, Hellström-Lindberg, Eva, Sanz, Guillermo, Čermák, Jaroslav, Stauder, Reinhard, Elena, Chiara, Germing, Ulrich, Mittelman, Moshe, Langemeijer, Saskia, Mądry, Krzysztof, Tatic, Aurelia, Holm, Mette Skov, Almeida, Antonio Medina, Savic, Aleksandar, Šimec, Njetočka Gredelj, Luño, Elisa, Culligan, Dominic, Guerci-Bresler, Agnes, Malcovati, Luca, van Marrewijk, Corine, Bowen, David, de Witte, Theo, Fenaux, Pierre
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 28.08.2018; American Society of Hematology; Elsevier
• Subjects: Myeloid Neoplasia
• ISSN: 2473-9529; 2473-9537; 2473-9537
• DOI: 10.1182/bloodadvances.2018020495

Prognosis of lower-risk (International Prognostic Scoring System [IPSS] low/intermediate-1) myelodysplastic syndrome (MDS) is heterogeneous and relies on steady-state assessment of cytopenias. We analyzed relative drops in neutrophil and platelet counts during the first 6 months of follow-up of lower-risk MDS patients. We performed a landmark analysis of overall survival (OS) of lower-risk MDS patients prospectively included in the European LeukaemiaNet MDS registry having a visit at 6 ± 1 month from inclusion to assess the prognostic relevance of relative drops in neutrophils and platelets, defined as (count at landmark − count at inclusion)/count at inclusion. Of 2102 patients, 807 were eligible for the stringent 6-month landmark analysis. Median age was 73 years. Revised IPSS was very low, low, and intermediate/higher in 26%, 43%, and 31% of patients, respectively. A relative drop in platelets >25% at landmark predicted shorter OS (5-year OS, 21.9% vs 48.6% with platelet drop ≤25%, P < 10−4), regardless of baseline IPSS-revised or absolute platelet counts. Relative neutrophil drop >25% had no significant impact on OS. We built a classifier based on red blood cell transfusion dependence (RBC-TD) and relative platelet drop >25% at landmark. Patients with none (62%), either (27%), or both criteria (11%) had 5-year OS of 53.3%, 32.7%, and 9.0%, respectively (P < 10−4). This classifier was validated in an independent cohort of 335 patients. Combining relative platelet drop >25% and RBC-TD at 6 months from diagnosis provides an inexpensive and noninvasive way to predict outcome in lower-risk MDS. This study was registered at www.clinicaltrials.gov as #NCT00600860. •A drop in platelet count >25% relative to baseline at 6 months from diagnosis predicts inferior outcome in lower-risk MDS.•Platelet drop combined with RBC-TD at 6 months provides an inexpensive and validated classifier of outcome in lower-risk MDS. [Display omitted]