Barosi et al developed a prognostic scheme for patients with myelofibrosis with myeloid metaplasia. A Cox regression model was used to study the outcomes in 137 patients. The study was done at the University of Pavia in Italy.
Parameters present at the time of diagnosis that were used to define risk groups:
(1) age in years
(2) hemoglobin
(3) percent immature myeloid cells in the peripheral blood
(4) red cell aplasia in the bone marrow
(5) erythrokinetic class III (in the absence of red cell aplasia in the bone marrow) based on total erythroid iron turnover (TEIT)
Erythrokinetic classes based on TEIT:
(1) Class I: TEIT > 450 µmol per liter blood per day
(2) Class II: TEIT 200 - 450 µmol per liter blood per day
(3) Class III: TEIT < 200 µmol per liter blood per day
Classification Tree Risk Presentation
|
Age |
Other Findings |
Risk Group |
|
<= 45 years of age |
immature myeloid cells in peripheral blood <= 24% |
low |
|
<= 45 years of age |
immature myeloid cells in peripheral blood > 24% |
intermediate |
|
> 45 years of age |
hemoglobin >= 13 g/dL |
intermediate |
|
> 45 years of age |
hemoglobin < 13 g/dL AND no red cell aplasia AND not erythrokinetic class III AND immature myeloid cells in peripheral blood <= 24% |
intermediate |
|
> 45 years of age |
hemoglobin < 13 g/dL AND (red cell aplasia OR erythrokinetic class III OR immature myeloid cells in peripheral blood > 24%) |
high |
|
Risk Group |
Survival |
|
low |
100% were alive at 15 years |
|
intermediate |
|
|
high |
median survival 69 months |
Risk Score Presentation
|
Parameter |
Finding |
Points |
|
age |
<= 45 years of age |
0 |
|
|
> 45 years of age |
1 |
|
hemoglobin |
>= 13 g/dL |
0 |
|
|
< 13 g/dL |
1 |
|
immature myeloid cells in the peripheral blood |
<= 24% |
0 |
|
|
> 24% |
1 |
|
red cell aplasia in the bone marrow |
absent |
0 |
|
|
present |
1 |
|
erythrokinetic class III (but not red cell aplasia) |
absent |
0 |
|
|
present |
1 |
risk score =
= (1.90 * (points for age)) + (0.85 * (points for hemoglobin)) + (1.25 * (points for immature myeloid cells)) + (4.8 * (points for red cell aplasia)) + (3.9 * (points for erythrokinetic)) – 6.51
If data is plugged into the equation, the following scores are associated with risk groups:
|
Score |
Risk |
|
-6.51 |
low |
|
-5.66 to -5.25 |
intermediate |
|
>= -2.51 |
high |
Specialty: Hematology Oncology
ICD-10: ,
