- Volume 1
- Issue 3 Publication Date: March 2007
Myelodysplastic Syndromes: Impact of Recently Analyzed Variables for Modifying Current Classification Methods
Jelena M. Kao, Peter L. Greenberg
The search for prognostic variables that can risk stratify patients with myelodysplastic syndromes (MDS), predict mortality, and predict transformation to acute myeloid leukemia dates back to the early 1980s and has since undergone many changes and refinements. The 3 major classifications of MDS remain the French-American-British classification based on morphologic criteria; the International Prognostic Scoring System based on bone marrow blast percentage, number of peripheral cytopenias, and karyotype; and the World Health Organization classification based on morphology, blast count, and cytogenetic abnormalities, all stratified into narrower subgroups. All 3 classifications have been proven to be useful in clinical decision-making and have been validated through single-center and multicenter studies of patients with MDS. Over the past decade, several new prognostic variables have been proposed to further refine MDS classification, including the following: serum lactic dehydrogenase, marrow cell immunophenotyping, red blood cell transfusion dependence, further subgrouping of cytogenetic abnormalities, human leukocyte antigen-DR subtyping, molecular markers, and genetic signatures. These more recently reported prognostic variables have demonstrated added prognostic value to previous classifications when individually evaluated in groups of patients with MDS. This review analyzes these data and provides a proposal for considering modification of the currently used standard classifications of MDS.