The MDS Beacon™

Research published in the October issue of Bone Marrow Transplantation validates the use of a new grouping scheme based on cytogenetics of myelodysplastic syndromes (MDS) and acute myelogenous leukemia (AML) patients undergoing stem cell transplants.

Cytogenetics refers to the study of parts of the cell associated with heredity, specifically the chromosomes.

Current patient grouping schemes like the International Prognostic Scoring System are based on cytogenetics. A patient is placed in a certain group based on their chromosome abnormalities. Members of a patient group generally have similar prognoses and risks for the disease. These groups can help determine the prognosis for a patient as well as the most effective treatment methods and timelines (see related Beacon news).

The authors of this study note that current methods of grouping are based on patients treated with supportive care and aggressive therapy, which may be insufficient for patients undergoing stem cell transplants. They claim that patients treated with stem cell transplants from outside donors may need a different grouping scheme based on cytogenetics of transplant patients.

In previous research, the authors had developed a new grouping scheme based on patients who had undergone stem cell transplants. The new grouping scheme encompasses two risk groups based on patient cytogenetics. The first group, described as an adverse-risk group, consisted of patients who have abnormalities of chromosome 7 and patients with more than three other chromosomal abnormalities. The second, or standard-risk, group included patients with any other chromosomal abnormalities.

To further validate their previous findings, researchers analyzed the medical records of over 500 patients who received stem cell transplants at three treatment centers. These patients included those who with MDS, those who had AML with an earlier diagnosis of MDS, and patients who had 20-30 percent marrow blasts. Donors for the transplants were mostly siblings as well as unrelated donors.

In their analysis, researchers examined the cytogenetics of each patient, and they followed each patient for time to relapse or death. The authors compared characteristics of cytogenetics for patients with similar time to relapse or death.

Researchers once again developed cytogenetic risk groups and found two distinct risk groups that were identical with the ones from their previous research.

The researchers found that patients in the first, or adverse risk, group had a poorer prognosis and lower overall survival rates over four years than patients of the second, or standard risk, group.

Patients in the adverse risk group had a 21 percent 4-year relapse-free survival rate and 23 percent overall survival rate, while rates in the standard risk group were 42 percent and 46 percent, respectively.

The standard-risk group had similar prognoses to patients without abnormalities in their chromosomes. This may indicate that finding an abnormality in a patient’s chromosomes may not necessarily place the patient in a high-risk group.

Researchers suggest using their new grouping scheme for patients with MDS or AML arising from MDS, who are candidates for stem cell transplants.

For more information, please see the study in the journal Bone Marrow Transplantation (abstract).