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Annals of Oncology Advance Access published online on July 15, 2009
Annals of Oncology, doi:10.1093/annonc/mdp264
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Prognostic impact of age and gender in 897 untreated patients with primary myelodysplastic syndromes

T. Nösslinger1,2, H. Tüchler2, U. Germing3, W. R. Sperr4, O. Krieger5, D. Haase6, M. Lübbert7, R. Stauder8, A. Giagounidis9, P. Valent4 and M. Pfeilstöcker1,2,*

1 Third Medical Department for Hematology and Oncology
2 Ludwig Boltzmann Institute for Leukemia Research and Hematology, Hanusch Hospital, Vienna, Austria
3 Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
4 Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Austria
5 Department of Hematology and Oncology, Elisabethinen Hospital, Linz, Austria
6 Department of Hematology and Oncology, University of Göttingen, Göttingen
7 Department of Hematology and Oncology, University of Freiburg, Freiburg, Germany
8 Department of Hematology and Oncology, Innsbruck Medical University, Innsbruck, Austria
9 Department of Hematology and Oncology, St Johannes Hospital, Duisburg, Germany

* Correspondence to: Dr M. Pfeilstöcker, Third Medical Department for Hematology and Oncology, Hanusch Hospital, Heinrich Collinstrasse 30, A-1140 Vienna, Austria. Tel: +431-91021-85411; Fax: +431-91021-85439; E-mail: michael.pfeilstoecker{at}wgkk.sozvers.at

Background: The International Prognostic Scoring System (IPSS) is the golden standard to assess prognosis in myelodysplastic syndromes (MDS). The aim of this analysis was to study age and gender as interacting variables for individualized prognostication.

patients and methods: In all, 897 patients with primary MDS treated with supportive care only were examined in a retrospective multicenter study. A Cox model was developed to determine the prognostic impact of age and gender on survival and to examine their modulating influence on IPSS results. Based on main effects and interactions of these variables, we established an individualized age- and gender-adapted scoring system to improve prognostication in MDS.

Results: While the risk of a patient in the IPSS is best represented by the values 0 (low), +1 (intermediate-1), +2 (intermediate-2), and +3 (high), these values were found to vary between –1.9 and +3.5 in the same patients when including age and gender. Whereas in low-risk MDS, male patients were found to have a less favorable survival, a particularly high risk (+3.5) was found in younger (≤66 years) high-risk female patients.

Conclusion: The inclusion of age and gender and their respective interactions contribute to improved and individualized prognostication in MDS.

age, gender, IPSS, MDS, prognosis

Received for publication August 22, 2008. Revision received January 5, 2009. Accepted for publication April 7, 2009.


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