The predictors of leukemia free survival in patients with myelodysplastic syndrome
DOI:
https://doi.org/10.15587/2519-4798.2018.132563Keywords:
myelodysplastic syndrome, acute leukemia, leukemia-free survival, prognostic factorsAbstract
The theoretical generalization and experimental confirmation of the features of the progression of myelodysplastic syndrome are presented in the article.
The purpose of the study was to identify the available clinical parameters that may be suitable for assessing of the course of MDS and predicting the risk of transformation of this pathology into acute leukemia.
The subject of the study was a group of patients with different subtypes of myelodysplastic syndrome according to the FAB classification. The statistical analysis was performed using the application software package STATISTICA for Windows 5.0 and NCSS. Leukemia-free survival was evaluated using the Kaplan-Meier method. To compare survival rates in two groups, the log-rank test and the Cox F-criterion were used. Cox proportional hazard regression was used to determine the most significant independent prognostic factors influencing the survival rate.
The obtained results indicate that the process of leukemic transformation of the low and high risk myelodysplastic syndrome is different, confirming the presence of different predictive risk factors for the transformation in these patients. It is statistically confirmed that the main predictors that shorten the leukemia free survival in patients with low-risk myelodysplastic syndrome are the age of patients above 60 years, multilineage dysplasia of bone marrow cells and serum TNF-α level above 10 pg/ml. Instead, in patients with high-risk myelodysplastic syndrome, besides the older age and multilineage dysplasia of bone marrow cells, with a shorter leukemia-free survival are also significantly associated: the presence of thrombocytopenia, increased blasts in bone marrow and the IL-6 concentration above 50 pg/ml.
Permanent search for prognostic factors and the development of new, more advanced prognostic scales that could cover not only demographic, laboratory or cytogenetic parameters, but also pathogenetic markers, are not only of scientific but also of a great practical importance, since they provide the opportunity to start therapy in patients with a high probability of transformation on time, thereby increasing the time to progression of the disease, in patients with MDS both low and high risk
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