Armand et al reported a prognostic score for a patient with myelodysplasia or acute leukemia who has undergone an allogeneic hematopoietic stem cell transplant. This can help to identify a patient who may require more aggressive management. The authors are from Dana-Farber Cancer Institute in Boston.
Patient selection: allogeneic stem cell transplant in a patient with myelodysplastic syndrome or acute leukemia
Parameters:
(1) age in years
(2) risk associated with hematologic disorder
(3) cytogenetics
(4) stage
(5) serum ferritin
|
Parameter |
Finding |
Points |
|
age in years |
< 40 years of age |
0 |
|
|
>= 40 years of age |
1 |
|
risk associated with disease |
low risk |
0 |
|
|
high risk |
1 |
|
cytogenetics |
favorable |
0 |
|
|
intermediate |
1 |
|
|
unfavorable (adverse) |
2 |
|
stage |
untreated MDS OR disease in first complete remission |
0 |
|
|
induction failure OR complete remission 2+ |
1 |
|
|
acute leukemia untreated OR acute leukemia in active relapse |
2 |
|
ferritin |
reduced-intensity conditioning OR < 2,500 ng/dL |
0 |
|
|
ablative AND >= 2,500 ng/dL |
1 |
where:
• The units for ferritin need to be checked. It is usually reported in ng/mL.
• For ALL unfavorable cytogenetics is t(9;22) or t(4;11).
• Low-risk MDS is RA, RARS or RCMD. High-risk <DS is RAEB.
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 7
• The higher the score the worse the prognosis.
|
Total Score |
Risk Group |
5-Year Overall Survival |
|
0,1 or 2 |
low |
56% |
|
3 |
intermediate |
22% |
|
4 to 7 |
high |
5% |
Specialty: Clinical Laboratory, Hematology Oncology, Surgery, general
