Evaluation of Clinical Characteristics and Prognostic Factors in the Patients of Myelodysplastic Syndrome

Kim, Jun Hwan; Lee, Kyung Hee; Hyun, Myung Soo

Abstract

BACKGROUND: Myelodysplastic syndrome (MDS) is a disorder of the hematopoietic pluripotent stem cell. The treatment modality and its prognosis were based on the FAB classification. But, because there is a variation of the clinical course, we evaluated the clinical characteristics and prognostic factors of MDS with score system. METHOD: We analyzed age, FAB classification, symptoms, peripheral blood and bone marrow findings of MDS patients for evaluation of clinical course and prognosis.
RESULTS
1) Age & Sex : Male to female ratio was 19:11, and age distribution was mainly over 5th decade (77%). 2) Subtype : The most common subtype was RAEB (43%), followed by RA (23%), RAEBT (17%), CMML (10%), and RARS (6.7%). 3) Initial symptom : The most common symptom was exertional dyspnea, followed by general weakness, headache, dizziness, and febrile sensation. 4) Peripheral blood : Anemia (<10g/dL) was noted in 90%, leukopenia (<2.5x109/L) in 36.6%, and thrombocytopenia (<100x109/L) in 73.3%. 5) Bone marrow finding : Hypocellularity was noted in 23%, normocellularity in 13%, hypercellularity in 63%. Bone marrow fibrosis was noted in 1 case of CMML. 6) Duration of mean follow-up period was 12.3 months and mean survival rate was 17.4 months. 7) The score of Sanz and Gattermann in the patient with RAEB and RAEBT were significantly higher than those of the patients with RA and RARS. Transformation to AML was seen in 5 cases with group C of Gattermann score. 8) With anabolic steroid therapy in 10 cases of RA & RARS, 2 cases were clinically improved, and with low dose Ara-C therapy in 5 cases, one case in RARS and another in RAEB were completely remitted but the latter converted to AML after 16 months.
CONCLUSION
The patients with RA and RARS have longer survival rate than the patients with other types of MDS. The score system of Bournemouth, Sanz and Gattermann were useful in evaluating the prognosis of MDS, being Gattermann score more valuable than those of Bournmouth and Sanz to predict the prognosis of MDS.