Georgescu Daniela 1, Patrinoiu Oana 1, Popescu Mihaela 1, Ciuhu Anda Natalia 2
1 “Colentina” Clinical Hospital, Haematology Clinic, Bucharest
2 “Sfantul Luca” Hospital, Oncology and Palliative Care Department, Bucharest
Abstract
Myelodysplastic syndromes (MDSs) represent a heterogeneous group of bone marrow conditions characterized by peripheral blood cytopenias and increased risk for evolution to acute leukemia. An accurate risk group classification constitutes the start point for the establishment of the therapeutic attitude in MDS pathology. The prognostic relies on different risk models, some of them being disease related: French- American-British system (FAB), World Health Organization classification, International Prognostic Scoring System (IPSS), WHO Prognostic Scoring System (WPSS), MD Anderson Scoring System (MDACC), while others being patient and comorbidities related: MDS- specific Comorbidity Index (MDS-CI). In 2012, Peter L. Greenberg and collaborators published in Blood the Revised International Scoring System (R-IPSS) that included MDS patients in five risk groups, based on cytogenetic changes. The evolution of patients with low risk MDS is heterogeneous and in most cases influenced by an associated pathology, considering that myelodysplasia occurs more frequently in elder people. By correlating the data in literature, a risk group classification was applied in the case of a 65 years old male patient, based on several of the above mentioned models. The patient was diagnosed with MDS in 2009 – refractory cytopenia with multilineage dysplasia and ringed sideroblasts (WHO 2008) in the Haematology Clinic of “Colentina” Hospital, Bucharest. At admission the patient presented a normal karyotype and he was classified in Intermediate 1 risk group (IPSS Int-1); Intermediate risk (WPSS); Low risk (MDACC); Low risk (MDS-CI). Our patient soon became transfusion dependent, with a requirement of 3 units of packed red blood cells per month and repeated hospital admissions. He also developed progressive left-ventricular dysfunction secondary to severe anaemia and recurrent transfusions. After approximately four years, in May 2013, the patient’s reclassification based on risk models indicated an intermediate risk (WPSS), the same as that at the moment of the diagnosis, but the associated comorbidities (transfusion dependency and heart failure) shifted him to a higher risk group, according MDS Co-morbidities Index (MDS-CI Int-High Risk), with low chances of survival, confirmed by his death shortly after, due to staphylococcal endocarditis but no leukemic transformation. Considering these events it becomes clearer that for MDS patients staged in low and intermediate risk groups, comorbidities represent an independent risk factor which entails a reassessment of the current prognostic systems.