Some patients with myelodysplasia classified as lower risk by the International Prognostic Scoring System (IPSS) may show rapid progression, Mittelman et al identified factors associated with a poor prognosis. The authors are from Tel Aviv University.

Patient selection: low risk or intermediate-1 MDS


Outcome: poor prognosis


General findings associated with worse survival:

(1) older age

(2) male gender

(3) significant comorbidities

(4) poor performance status


Cytopenias and blood transfusion:

(1) anemia

(2) thrombocytopenia

(3) absolute neutropenia

(4) need for repeated transfusion

(5) elevated serum ferritin and iron overload


Laboratory values:

(1) elevated serum LDH concentration


Bone marrow findings:

(1) fibrosis

(2) blast islands (clusters of CD34 positive cells)

(3) multi-lineage dysplasia

(4) normal or high cellularity (versus hypoplasia)



(1) increased CD34 (blast marker)

(2) increased CD13

(3) increased CD45

(4) increased HLA-Dr

(5) low CD11b

(6) increased BCL2



(1) additional chromosomal abnormalities (versus low risk pattern)

(2) chromosomal instability


Genetic testing:

(1) 6-gene poor risk signature

(2) unmutated TET2

(3) mutation ASXL1


Other (may not be readily available):

(1) short telomeres

(2) high telomerase activity

(3) cell senescence (PIG INKa4)

(4) P15 INK4b methylation


(6) high methylation

(7) down regulation LEF1

(8) increased caspase3

(9) clonal granulocytes



• Some of the measures in the IPSS are subject to inter-observer variability.

• Patients classified as intermediate-1 MDS would seem more likely to progress.

• MDS evolves over time and so requires periodic evaluation, especially when diagnosed early in its course.

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