• J. Intern. Med. · Apr 2024

    Early transfusion patterns improve the Molecular International Prognostic Scoring System (IPSS-M) prediction in myelodysplastic syndromes.

    • Maria Creignou, Elsa Bernard, Alessandro Gasparini, Anna Tranberg, Gabriele Todisco, Pedro Luis Moura, Elisabeth Ejerblad, Lars Nilsson, Hege Garelius, Petar Antunovic, Fryderyk Lorenz, Bengt Rasmussen, Gunilla Walldin, Teresa Mortera-Blanco, Monika Jansson, Magnus Tobiasson, Chiara Elena, Jacqueline Ferrari, Anna Gallì, Sara Pozzi, Luca Malcovati, Gustaf Edgren, Michael J Crowther, Martin Jädersten, Elli Papaemmanuil, and Eva Hellström-Lindberg.
    • Center for Hematology and Regenerative Medicine (HERM), Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
    • J. Intern. Med. 2024 Apr 23.

    BackgroundThe Molecular International Prognostic Scoring System (IPSS-M) is the new gold standard for diagnostic outcome prediction in patients with myelodysplastic syndromes (MDS). This study was designed to assess the additive prognostic impact of dynamic transfusion parameters during early follow-up.MethodsWe retrieved complete transfusion data from 677 adult Swedish MDS patients included in the IPSS-M cohort. Time-dependent erythrocyte transfusion dependency (E-TD) was added to IPSS-M features and analyzed regarding overall survival and leukemic transformation (acute myeloid leukemia). A multistate Markov model was applied to assess the prognostic value of early changes in transfusion patterns.ResultsSpecific clinical and genetic features were predicted for diagnostic and time-dependent transfusion patterns. Importantly, transfusion state both at diagnosis and within the first year strongly predicts outcomes in both lower (LR) and higher-risk (HR) MDSs. In multivariable analysis, 8-month landmark E-TD predicted shorter survival independently of IPSS-M (p < 0.001). A predictive model based on IPSS-M and 8-month landmark E-TD performed significantly better than a model including only IPSS-M. Similar trends were observed in an independent validation cohort (n = 218). Early transfusion patterns impacted both future transfusion requirements and outcomes in a multistate Markov model.ConclusionThe transfusion requirement is a robust and available clinical parameter incorporating the effects of first-line management. In MDS, it provides dynamic risk information independently of diagnostic IPSS-M and, in particular, clinical guidance to LR MDS patients eligible for potentially curative therapeutic intervention.© 2024 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.

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