林建廷April 28, 2008

IPSS for MDS (FAB classification)◦ Greenberg P et al. International scoring system for

evaluating prognosis in myelodysplastic syndromes. Blood. 1997; 89: 2079-2088. (Erratum in Blood 1998; 91: 1100)

WPSS for MDS (WHO classification)◦ Germany. Time-dependent prognostic scoring system for

predicting survival and leukemic evolution in myelodysplastic syndromes. J Clin Oncol. 2007; 25: 3503-3510.

Free from

IPSS for MDS (FAB classification)◦ Greenberg P et al. International scoring system for

evaluating prognosis in myelodysplastic syndromes. Blood. 1997; 89: 2079-2088. (Erratum in Blood 1998; 91: 1100)

WPSS for MDS (WHO classification)◦ Germany. Time-dependent prognostic scoring system for

predicting survival and leukemic evolution in myelodysplastic syndromes. J Clin Oncol. 2007; 25: 3503-3510.

OS Risk of AML

Time-dependent WPSS

Both from IPSS and WPSS, the estimated OS is about 2 yrs, and 5-yr survival probability is about 15-25%

Therefore, further treatment other than BSC is indicated.◦ ATG/CsA◦ Azacitidine/Decitabine◦ Allo-SCT

NIH. A simple method to predict response to immunosuppressive therapy in patients with myelodysplastic syndrome. Blood. 2003; 102: 3025-3027.

◦ ATG + CsA (regardless of blast percentage)

Fred Hutchinson CRC. Hematopoietic cell transplantation-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood. 2005; 106: 2912-2919

◦ Ablative (n=761) vs nonablative (n=294)◦ Related (58%) vs unrelated (42%)◦ PB(71%) vs Marrow(29%)◦ GVHD prophylaxis with CsA/MTX(82%) or

CsA/MMF(18%)◦ GVHD tx with steroid or reinstitution of CsA◦ Infection prophylaxis with Fluconazole, (Ceftazidime or

Ciproxin), (Baktar or Dapsone), Acyclovir if sero(+)

N=122◦ Pulmonary toxicities (24%)◦ GVHD (11%)◦ Infections (45%)

Infection + GVHD (18%) Infection – GVHD (27%)

◦ Others (20%)

HCT-CI did not take into consideration including age, underlying disease and type of transplantation

◦ Predict 2-yr Allo-SCT mortality (any cause) Fred Hutchinson CRC. A risk score for mortality after

allogeneic hematopoietic cell transplantation. Ann Intern Med. 2006; 144: 407-414 n=2802 Predict survival within 2 yrs

Risk Groups

Low CML in CPRAAA

Int CML in APCML BP then CPAcute leukemia in remissionLymphoma in remissionRAEBCLLPNH

High CML in BPAcute leukemia in relapseLymphoma in relapseRAEB-tMyelomaSolid cancer

1. Age2. Donor type3. Dz risk4. Conditioning

regimen5. FEV16. DLCO7. Cre8. GPT

Category

Score Probability of Death

1 9-16 <25%

2 17-23 25-50%

3 24-30 50-75%

4 31-44 >75%

Fred Hutchinson CRC. Comorbidity and disease status-based risk stratification of outcomes among patients with acute myeloid leukemia or myelodysplasia receiving allogeneic hematopoietic cell transplantation. J Clin Oncol. 2007; 25: 4246-4254

Risk Group

(by FAB classification)

Low De novo AML in CR1RARA-RS

Int De novo AML in CR2 or more

High All others