An HIV-positive patient with myelodysplasia may have a poor outcome. Kaner et al identified prognostic factors for these patients. The authors are from Albert Einstein College of Medicine and Montefiore Medical Center in New York City.
Patient selection: HIV-positive myelodysplastic patient
Clinical findings associated with myelodysplasia in an HIV-positive patient include:
(1) younger age
(2) rapid progression to acute leukemia
(3) worse median survival (11 months vs 69 months)
Risk factors for a worse prognosis:
(1) clonal-hematopoiesis related mutations (ASXL1, DNMT3A, TP53)
(2) presence of high-risk cytogenetics (chromosome 7 anomalies, other)
(3) severe neutropenia and/or thrombocytopenia
(4) higher risk (intermediate-2 or high) by IPSS
Other factors that contribute to a worse prognosis:
(1) severe immunodeficiency
(2) severe antiretroviral drug toxicity
(3) severe malnutrition
