Which risk-stratification systems should I use for prognosis of newly diagnosed MDS patients?

FAQ Library published on June 11, 2014
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Rami S. Komrokji, MD
Professor of Medicine and Oncologic Sciences
University of South Florida College of Medicine
Vice Chair, Malignant Hematology Department
Moffitt Cancer Center
Tampa, Florida
Which risk-stratification systems should I use for prognosis of newly diagnosed MDS patients?
Hi, I am Rami Komrokji from H. Lee Moffitt Cancer Center, I am the lead clinical investigator for the MDS program. Obviously we read about several risk stratification models, there is the pathological classification WHO, FAB, there is IPSS-Revised, IPSS Global MD Anderson model, lower risk MD Anderson model, WHO prognostic scoring system. So which one we should use and practice for prognosis of newly diagnosed MDS? Again, in an academic setting, one could calculate all those risk models for the patient, in real life that becomes difficult and the value of that is not clear. There is no doubt that IPSS had been the gold standard for several years, many of the clinical trials and drug approval available in the market is based on the IPSS risk stratification, so it remains as an important first step. However, again, there is no doubt that there are shortcomings, there are cases where the IPSS underestimates the disease risk more than actually overestimating the disease risk, so in newer models like the revised IPSS or the Global MD Anderson Model could be supplementary. And now also over the next few years I am sure we will be incorporating gene mutation data from next gen sequencing and diagnostic and prognostic applications for MDS. In our practice we typically calculate the IPSS, we supplement the IPSS either with the revised IPSS or the Global MD Anderson Model to identify those patients that could be upstaged, probably somewhere between 15% to 25% of the patients that have higher risk disease features than one would think originated by the IPSS. We obtained molecular single gene mutations by next gen sequencing, mostly for prognostic value, but the utility and tailoring therapy is still investigational. Thank you very much for listening.
Last modified: May 29, 2014
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