Prognostic factors and evaluation of response to treatment in patients with MDS

Myelodysplastic syndromes (MDS) are a diverse group of hematological disorders with peripheral blood cytopenias, abnormal cellular maturation and migration, ineffective hematopoiesis, genetic abnormalities, and an increased likelihood of developing acute myeloid leukemia (AML). Evaluation of prognosis is an important element of MDS management. Intensive and complicated treatments can be preferred in patients who are thought to have a poor prognosis according to the prognostic score. In the group with a low prognostic score, supportive treatments can be given to increase the quality of life(1-3). Studies show that EPO therapy is an effective treatment for anemia in low-risk MDS(4-6). The use of hypomethylating agents is common in patients with high-risk disease. In our study, we aimed to evaluate cytogenetic and FISH results, demographic data, prognostic factors, laboratory characteristics, treatment options, and response to treatment in patients with MDS who were followed up by Ondokuz Mayıs University Faculty of Medicine, Department of Hematology between May 2012 and January 2022. 81 cases were analyzed retrospectively. Six patients who were not followed up after diagnosis were excluded from the study. Patients' age at diagnosis, gender, date of diagnosis, hemoglobin, white blood cell, neutrophil, lymphocyte, monocytes, platelet values at diagnosis, ferritin, folic acid and vitamin B12 values, treatment types, bone marrow blast percentages in flow cytometry, cytogenetic and FISH results, r-IPSS score was recorded. Based on the response criteria for haematological improvement according to the modified IWG, response to treatment was determined. In this context, the patients were divided into two groups as those who responded to the treatment and those who did not. Prognostic factors were compared between the two groups. Genetic data of 15 patients out of 75 patients included in the study could not be accessed. Therefore, the r-IPSS score and WHO classification of 15 patients could not be made. Anomaly was not detected in 51 (85%) patients. There were genetic anomalies in nine (15%) patients. The genetic anomalies we detected were consistent with the anomalies seen frequently in MDS. There were 46 patients who responded to treatment and 29 patients who did not respond to treatment. There was no significant difference between the treatment-responsive and unresponsive groups in terms of age and gender. The white blood cell and neutrophil counts were higher and the blast counts were lower in the treatment-responsive group. 49 (65.3%) patients were treated with EPO and 26 (34.7%) patients with hypomethylation agents. Of the patients who received EPO, 35 (71.4%) had a response to treatment, 14 (28.6%) did not. 97% of patients who responded to EPO treatment were in the very low and low risk group. In our study, the response to EPO treatment was 71.4%. Studies have shown that the response rate to EPO treatment is very diverse. Of the patients who received hypomethylation agents, 11 (42.3%) had a response to treatment, and 15 (57.7%) had no response to treatment. Response rates to treatment were similar to literature data. In conclusion, MDS is a clinically complex disease that requires genetic studies in both treatment selection and prognosis. Almost all prognostic scoring is based on cytogenetic data. The treatment approach should be determined by considering the age and comorbid conditions of the patients. However, response rates to treatment vary widely in the literature. Therefore, more prospective studies are needed in the evaluation of treatment response.