The MDS Beacon™

A recent study from Heinrich-Heine University in Germany reveals that the success of chemotherapy on patients with myelodysplastic syndromes (MDS) or acute myelogenous leukemia (AML) may be predicted using cytogenetic studies before and after the therapy. Cytogenetics refers to the study of the structure and function of cells, specifically the chromosomes. Understanding and analyzing the cytogenetic findings at the time of diagnosis helps influence prognosis as well as the path of therapy recommended for each patient.

Scientists studied 118 patients with MDS or AML and abnormalities in their chromosomes. These patients received chemotherapy as their initial treatment. A cytogenetic analysis was conducted at the time of diagnosis and again after chemotherapy. Patients were divided into low-risk, intermediate-risk, and high-risk groups based on their chromosome abnormalities.

Seventy percent of patients achieved complete remission, 17 percent achieved partial remission, and 13 percent did not respond to the therapy. Patients classified in the low-risk group were most likely to achieve full remission.

Among the patients who achieved complete remission, 26 still showed an abnormality in their chromosomes after the therapy. Patients who had an abnormality following treatment had a median survival of 11 months. In comparison, patients without abnormalities had a median survival of 37 months. Patients who did not achieve complete remission had a median survival of eight months.

Other factors also attributed to better prognosis. Patients under the age of 50 showed a better response to the therapy. Patients with de novo AML, meaning AML without having had MDS previously, had a better response to therapy than did MDS patients or patients who developed AML following MDS.

Results of the study showed that studying the chromosomes through cytogenetic studies before and after stages of chemotherapy can help to predict the success of future stages. Cytogenetic studies can also indicate a need for more intensive therapy.

A previous study published in the Journal of Clinical Oncology in 2004 showed similar results. The study data support a correlation between abnormal chromosomes and higher risk of treatment failure.

Cytogenetic testing is considered labor-intensive and requires field expertise. Researchers note, however, that early identification of patients at high risk of relapse is important to planning treatment. They recommend that any patient who is intermediate-risk based on the initial cytogenetic test should be further assessed to make decisions about the best possible therapy plan. Furthermore, patients with abnormal chromosomes after chemotherapy should be considered high-risk and evaluated for more intensive therapy.

For more information, see the study in the journal Leukemia Research (abstract).