Study Uses Hemoglobin as a Continuous Variable to Refine Prognosis in Myelodysplastic Syndromes

The Revised International Prognostic Scoring System (IPSS-R) is the standard tool to predict prognosis for patients with myelodysplastic syndromes (MDS). It uses a variety of clinical and cytogenetic criteria:

  • Hemoglobin
  • Absolute neutrophil count
  • Platelet count
  • Bone marrow blasts
  • Cytogenetic category

Recently, research has explored another potential prognosis tool: a panel comprised of four stemness-related genes—LAPTM4BNGFRAP1EMP1, and CPXM1. The panel, known as LSC4, has been shown to surpass the IPSS-R in regard to survival classification performance.

Building upon that work, a group of researchers from MD Anderson Cancer Center has been evaluating the LSC4’s predictive abilities and developing novel models that combines RNA-sequencing data with clinical variables to further improve prognostic capabilities. They presented results at the 62nd ASH Annual Meeting & Exposition.

The team evaluated bone marrow mononuclear cells from bone marrow samples of 56 patients with MDS before they received any treatment.

They applied the LSC4 panel on their data set, then also applied the IPSS-R. In addition, in order to improve the model’s performance, they calculated clinical features with survival status.

The study found that hemoglobin, as a continuous variable, had a significant ability to predict overall survival (OS). The researchers said it could be combined with IPSS-R or LSC4 scores to greatly improve survival classification performance.

Furthermore, they reported, increasing hemoglobin even by a single unit can improve OS in a patient with MDS.

“Our proposed models show an enhanced time area under the curve performance when focusing on survival status beyond 20 months of follow-up compared with IPSS-R and LSC4 scores,” said presenter Faezeh Darbaniyan, PhD, in the Department of Biostatistics at the University of Texas MD Anderson Cancer Center in Houston.

The team also observed that combining hemoglobin with the LSC4 or IPSS-R significantly improved the confidence interval for long-term survival.

“In fact, in these panels, unlike the IPSS-R panel, we treat hemoglobin as a continuous variable, and we believe factorial consideration of hemoglobin can underestimate the true effect of this feature on survival,” Dr. Darbaniyan said.