Comparison of the IPSS and IPSS-R in Predicting Survival and Response of Myelodysplastic Syndrome Patients to 5-Azacitidine
Notice bibliographique
Résumé
Background The international prognostic risk score (IPSS) is a validated tool in the prognosis of myelodysplastic syndromes (MDS). Patients who fall into the Int-2 and High categories of the IPSS qualify for treatment with 5-azacitidine, a hypomethylating agent that has been shown to provide a survival advantage with these prognostic risk scores. The IPSS was recently updated, with the newer revised IPSS (IPSS-R) risk score taking into account more cytogenetic data than the IPSS. It has not yet been determined whether the IPSS-R provides an advantage over the IPSS in predicting outcome with 5-azacitidine. The objective of this study was to reclassify a cohort of MDS patients at a single academic center using the IPSS-R, and to determine its ability to predict survival and response to 5-azacitidine. Methods This study was approved by the institutional board review. A total of 97 patients with a diagnosis of MDS were treated with 5-azacitidine at the London Health Science Center up until 2015. Both the IPSS and IPSS-R could be calculated for 77 patients. Kaplan-Meier survival curves were constructed for the patients categorized based on the IPSS and IPSS-R. The scores were also compared based on objective response rates (ORR = complete response + partial response + hematologic improvement) as defined by the IWG 2006 criteria that were determined for all patients. Results All 77 patients included in the study had qualified for 5-azacitidine treatment according to provincial criteria, and had an IPSS score int-2 or high. Upon reclassification using the IPSS-R, 2/77 patients were scored as low, 14/77 patients were scored as intermediate, 24/77 patients were scored as high, and 37/77 patients were scored as very high risk. Kaplan-Meier survival analysis (Figure 1) indicated there was no statistically significant difference between the IPSS-R intermediate, high, and very high survival curves (log-rank p = 0.774). The objective response rate for all 77 patients treated with 5-azacitidine was 23%, with ORR of 21% for IPSS-R intermediate, 17% for IPSS-R high, and 38% for IPSS-R very high. Conclusions The IPSS-R is an alternative prognostic risk scoring system that takes into account additional cytogenetic data compared to the IPSS. In our center the IPSS-R has not resulted in prognostic risk categories that are an improvement over the IPSS in predicting survival in response to 5-azacitidine. The IPSS-R very high risk patients had double the objective response rate to 5-azacitidine compared to the intermediate and high risk groups. Disclosures Lazo-Langner: Bayer: Honoraria; Pfizer: Honoraria; Daiichi Sankyo: Research Funding.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».