ASH 2011 967 A Prognostic Model of Therapy-Related Myelodysplastic Syndrome for Predi

[akita]

967 A Prognostic Model of Therapy-Related Myelodysplastic Syndrome for Predicting Survival and Transformation to Acute Myeloid Leukemia

http://ash.confex.com/ash/2011/webpr...aper39970.html

"Background: A significant fraction of patients with MDS have a prior history of an antecedent malignancy treated with chemotherapy and/or radiotherapy. Therapy related MDS (t-MDS) differs from de novo MDS in its high frequency of chromosomal abnormalities (typically in the context of complex karyotypes), high rate of transformation to acute myeloid leukemia (AML), and high resistance to standard MDS therapy. MDS prognostic models (e.g., IPSS, WPSS) have been developed based primarily on cohorts of patients with de novo MDS. We evaluated the characteristics of a large cohort of patients with t-MDS and created a specific t-MDS prognostic model."

There are typical differences between t-MDS and novo MDS.

1. In t-MDS - many patients with chromosomal abnormalities, typically within complex karyotypes

2. In t-MDS - high rate of transformation to acute myeloid leukemia (in MDS the rate is not so high in de novo MDS- patients)

3. In t-MDS in many cases the standard MDS-therapies don`t help

"Conclusion: We propose a prognostic model specific for patients with t-MDS that predicts overall and leukemia-free survivals. This model may facilitate the development of risk-adapted therapeutic strategies."

There is a prognostic model proposed in this study report for patients with t-MDS. This could be helpful to choose the best therapies for these patients (perhaps not so long watch-and-wait, earlier onset of medical therapies..)

This model does not give a prognosis for the overall-chances of t-mds-patients, but helps to optimize treatments

Margarete

[Darice]

Interesting . . . eager to read more, but it seems to consider more factors than the MDAnderson model. Both point up some of the differences between dealing with de novo and therapy-related MDS . . . which the IPSS doesn't differentiate. Here's a link to the MD Anderson study:

http://onlinelibrary.wiley.com/doi/1...ncr.23697/full

Sometimes I wonder whether I really want to read more or not. Gets discouraging . . . but I see that this needs to be considered in choosing treatment.

[akita]

>Interesting . . . eager to read more, but it seems to consider more factors than the MDAnderson model.

Isn`t this new model a step forward, - creating a specialised prognostic system for the group of t-mds-patients ?

When the study says "This model may facilitate the development of risk-adapted therapeutic strategies" , this means that it could make it easier for the professionals/researchers/clinicians to develop better therapeutic strategies (for the health system, for all patients with t-MDS, not only for the special patient). In this sense, i was wrong when i wrote about "choosing therapies" and "optimizing treatments" - these should be developped in the future, are not yet available...

Thank you for the link!

>Sometimes I wonder whether I really want to read more or not. Gets discouraging . . . but I see that this needs to be considered in choosing treatment.

Perhaps all these details are more relevant for science and not so much for the patients personally. These are sort of standard treatments which are then designed after so big studies/evaluation of big patients "cohorts". These treatments might form "school medicine" with standard medicaments/chemicals in opposite to the daily work and sorrows at home with many, many forms of "private therapies" (sleep, diet, care, activities, collecting informations, keeping contacts...) which happen outside of the clinic and who are extremely important and deciding concerning the health of the patient...

Not to forget, that these scoring systems are developped for designing better studies and are read normally only by scientists, and they are designed for their view.. This is a special world, and the researchers might read these studies with a sort of professional coolness. As everybody you meet in forums could confirm, the personal patients`biographies are different from these "prognostic score"- artificial agegroup, bilirubingroup- scoringgroup - etc.-biographies.

It could (imho) extremely advanteous for a patient if he/she can usually cope with therapies. I was such a type, but experienced when i was in hospital for months, that many patients are unluckily very sensible and must stop with the therapy shortly after the start. Here the best prognosis, given by a scoring system, does not help. And the opposite can happen, when an old lady (whom i met and who gave me much hope) gets one cancer-disease after the other and survives this all - despite of the negative prognoses.

Wishing you - in this sense - a favourable ongoing of therapies,

Kind regards,

Margarete