MDS Classification Tool Feedback

[akita]

Just tried to use the MDS Classification Tool on this Webside.

It seemed to me very useful. Very specialized questions are not adressed e.g. that sometimes a chromosomal mutation of two different aberrations is better for the prognosis than having only one ore precise differentiations between ITP and MDS. etc.. These problems could be tried to explain by "normal" forum communication. I just have copied the MDS Part of the WHO Classification 2008 in our library at the MedUniWien and now really should have the exact informations.

--

Sorry, that the system actually did not work for me. I completed the questionnary, - but there was no result indicated on the screen. Is it because of my weak downloading capacity or could there exist other reasons ?

Asking for help,

Margarete

[Neil Cuadra]

Margarete,

I'm sorry the MDS Classification Tool didn't work as expected.

When it works, the little circled letters indicate the areas you have to fill in so that the classification will display. In other words, if you fill in the fields marked Ⓘ then the IPSS score should display. If you fill in the fields marked Ⓦ then the WHO classification should display. And if you fill in the fields marked Ⓕ then the FAB classification should display. If they don't, then I'm sure we can figure out why.

The most common reason for the tool not working is that JavaScript isn't enabled in a user's web browser. So let's start with that check. Please check if JavaScript is working using our JavaScript test page. Does it say "JavaScript is enabled" or "JavaScript is NOT enabled"?

[Greg H]

Hey Neil!

While Margarete's issue may be more of a technical computer issue, I thought I'd take the opportunity of this tread to weigh in on a more substantive issue with the tool, which I think is a very fine idea on the whole.

For the moment, I'm only interested in the IPSS portion, since that seems to be the basic tool that most docs, patients, and NGOs like to reference.

If I enter my current stats, I have three cytopenias, which gets me a half point, and less than five percent blasts, which nets a zero. So far, so good.

If I then crank in my Trisomy 8, I pick up a full point, and get an INT-2 score. I'm not sure if this is a mistake or based on some evaluation of Trisomy 8 as a "Poor" Karyotype. The NCCN Guidelines on MDS offer the following guidance on karyotype: "Cytogenetics: Good = normal, -Y alone, del(5q) alone, del(20q) alone; Poor = complex (>=3 abnormalities) or chromosome 7 anomalies; Intermediate = other abnormalities. [This excludes karyotypes t(8;21), inv16, and t(15;17), which are considered to be AML not MDS.]"

No specific mention of Trisomy 8, so it gets an "intermediate" half point. I am betting the tool is relying on some other resource to score cytogenetics. Can you fill me in?

I'm aware that the question of how to rate cytogenetics may be an area of some disagreement amongst researchers, because I have seen other breakdowns than the one cited above. I can offer that each of the docs I have consulted has rated me INT-1, considering Trisomy 8 an "intermediate risk" karyotype and awarding me half a point in that category for my trouble.

Thanks and Happy New Year!

Greg

[tytd]

I think Greg and Margarete have detected an error in the MDS or IPSS calculation tool on this website. As Greg says the trisomy 8 is an intermediate category cytogenetics and should only be giving him .5 score to make his total score 1.0 or int-1. Instead the calculator gives a 1 for trisomy 8 and makes an error in giving him a total score of 1.5 or Int-2. Someone needs to do some tweaking of the tool as it might be frightening some people into thinking they have higher risk disease. There is a newer MD Anderson Prognosis Scoring System which may prove to be a better prognostic tool. I think Dr. Roboz showed it in one of her recent webinars on the AAMDS site. I'll try to post it if I can find a link.

[akita]

1. A prognostic score for patients with lower risk myelodysplastic syndrome Prognostic model of lower risk MDS (Only abstract free avaible, but the journal is in the Viennese MedUni-Library and supposedly in some more libraries)

http://www.nature.com/leu/journal/v2.../2405070a.html

2. Proposal for a new risk model in myelodysplastic syndrome that accounts for events not considered in the original International Prognostic Scoring System 2008
Free Fulltext

Here is mentioned a copyright for the MD Anderson Prognostic Risk Model by ..... but i could not yet find the original

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

3. This year ASH reported a validation of the MD Anderson Prognostic Risk Model

444 Validation of the Newly Proposed MD Anderson Prognostic Risk Model for Patients with Myelodysplastic Syndromes

http://ash.confex.com/ash/2010/webpr...aper29616.html

---

I think it helps identifying some persons with IPSS Lower-Risk, who should belong to a higher risk class because of several additional parameters, like age, low platelets etc, that are not indicated in the IPSS. This Risk Model also helps to make a helpful prognosis for some groups of patients who have not been included in validation of original IPSS many years ago, like MDS patients with prior treatments like transfusions. This is important for conducting investigational studies in a more adaequate way. At the time of creation of IPSS most MDS patients were primary MDS and almost not pre-treated. This has changed. Most of the people who undergo studies for new medicaments have already had prior treatments. How to estimate their prognosis? This risk model has been proved to be valide for all MDS-Patient Groups, not only for the prior not treated primary MDs like IPSS was. So it could help of course (so i think) to contribute to a better choice of therapy. When you are classified by IPSS only you could perhaps have Low-risk or Int-1 status, but b< MD Anderson you could have a higher risk-status. So that perhaps another therapy must be chosen to help you.

Kind regards,

Margarete

[Neil Cuadra]

Thanks for testing the tool. We fixed the computation for the case of a single chromosome abnormality.

The tool follows the definitions in Dr. Greenberg's original article: International Scoring System for Evaluating Prognosis in Myelodysplastic Syndromes, Blood, Vol 89 No 6, 1997, which defines the karyotype categories as follows:

Good, normal, -Y, del(5q), del(20q); Poor, complex (>=3 abnormalities) or chromosome 7 anomalies; Intermediate, other abnormalities.

Trisomy 8 is not itemized, so it falls into the "other abnormalities" category under the IPSS. The newer IPSS-R system specifically itemizes trisomy 8.