Prognostic VALUE of EARLY Drop in the Platelet Counts in Patients with VERY Low, Low and Intermediate Risk IPSS-R Myelodysplastic Syndromes. Results from a Single Center Analysis

Abstract

Background: Prognosis of very low, low and intermediate risk myelodosplastic syndromes (MDS) is heterogeneous. Recently, the EUMDS (European Leukemia Net Lower-Risk MDS) described that a 20% drop in platelet counts in the first 6 months after diagnosis of patients with lower risk MDS identifies a poor-risk population independently from the IPSS-R. Herein, we present the impact of an early drop in both platelet and neutrophil counts during the first 6 months after diagnosis in a population of patients with lower and intermediate IPSS-R risk MDS.Patients and Methods: A total of 270 consecutive patients diagnosed with MDS (01/2010-12/2016) at the Catalan Institute of Oncology of Barcelona were included in the study. 201 patients were eligible for the study. Reasons for exclusion were: absence of a medical visit at 6 month or later on (n=9), higher-risk MDS patients (n=40) and patients under treatment with hypomethylating agents, lenalidomide or hydroxycarbamide at the follow up visit (n = 20). Patients were classified into two groups according to the presence or not of a 20% drop in neutrophils and platelets at time of or before the landmark time point. Landmark analysis was conducted at 6 months after diagnosis. We analyzed in our series the prognostic impact of early drop in neutrophils and plateletsin both overall survival (OS) and leukemia free survival (LFS).Results: Median age at diagnosis was 75 years and 135 (67.2%) were male. According to the WHO 2008 classification, 3% of the patients were classified as CRDU, 7.5%RA, 48.8% RCMD, 8.5% RAEB‐1, 1%, RAEB‐2, 27.4% CMML, the remaining 4% were MDS‐U and isolated 5q deletion. Hemoglobin, neutrophiland platelet counts were of 11.2 g/dL (5.6-16.9) [median (range)], 2.71 x109/L (0.3-30), 149 x109/L (1-889), respectively; the percentage of bone marrow blast at diagnosis was 2% (0-13). 47% of the patients were diagnosed with a very low IPSS-R, 42% with a low IPSS-R and the remaining 11% with intermediate IPSS-R. At the time of last follow up, 74 (36.3%) patients had died and 17 (8.5%) had progressed to AML.The median time to the landmark blood test was 188 days (1QR: 160-218). Median follow-up from landmark was 31.4 months. Median relative drop in platelets was 2.4%. In univariate analysis male sex, number of cytopenias, IPSS-R, red blood cell transfusion dependency (RBC-TD) and a platelet drop >20% was associated with poorer OS (Figure 1). In multivariate testing, male sex, RBC-TD and a drop of platelets >20% within 6 months were independent significant parameters affecting survival (Table 1). Number of cytopenias, IPSS-R and RBC-TD were associated to an inferior LFS in univariate analysis. IPSS-R was the only independent adverse prognostic factor for LFS in the multivariate analysis. The combination of both RBC-TD and a platelet drop >20% at 6 month after diagnosis enabled us to identify a small subgroup of patients (6%) with a median OS of 20 months.Conclusion: A 20% drop in platelet counts in the first 6 months after diagnosis is able to identify a poor-risk population of patients with MDS within the very low, low and intermediate-risk IPSS-R groups. As therapeutical decisions are based on prognostic risk assessment, the inclusion of this additional parameter may help to better tailor treatment strategies in these patients. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.