Myelodysplastic syndromes (MDS) comprise a heterogeneous group of myeloid disorders with heterogeneous clinical manifestations and outcomes, ranging from those asymptomatic patients with long-life expectancy, to those with profound cytopenias and high risk of evolution to an acute myeloid leukemia. Treatment options have been based on risk prognostic stratification according to the International Prognostic Scoring System (IPSS), being conservative in the low-risk group: IPSS low and intermediate-1 (IPSS < 1.5 points), whereas intensive in the high-risk group: intermediate-2 and high (IPSS > 1.5 points) patients. Therefore, a proper prognostic assessment is mandatory in MDS. Autoimmune disorders (AD) have been described in MDS, however, its real incidence and prognostic effects in these patients are not completely understood. Moreover, a revised IPSS (IPSS-R) has been recently published and which is the best cut-point that stratifies patients into low and high-risk group has not been established. Against this background, in the first work we have analyzed the prevalence, clinical characteristics and outcomes of AD in MDS patients, and we have demonstrated that AD are a common feature in MDS and what is more important, present a worse prognostic impact in these patients. In the second work, we have analyzed in a large cohort of MDS patients which is the best IPSS-R threshold that divides MDS in low vs high-risk groups, being 3 points the best cut-point. According to our results, MDS with AD and those with an IPSS-R > 3 points should be considered as high-risk patients and therefore considered treatment with intensive regimens.
Improvement strategies for the prognostic evaluation of myelodysplastic syndrome patients.
Montoro Gómez, M. J. (Author). 18 Sept 2019
Student thesis: Doctoral thesis
Student thesis: Doctoral thesis