Clinical Outcomes of Decitabine Treatment for Patients With Lower-Risk Myelodysplastic Syndrome on the Basis of the International Prognostic Scoring System

Ki Sun Jung, Yoo Jin Kim, Yeo Kyeoung Kim, Sung Kyu Park, Hoon Gu Kim, Soo Jeong Kim, Jinny Park, Chul Won Choi, Young Rok Do, Inho Kim, Seonyang Park, Yeung Chul Mun, Seong Hyun Jeong, Min Kyoung Kim, Hyeon Gyu Yi, Myung Hee Chang, Su Youn Kim, Je Hwan Lee, Jun Ho Jang

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Abstract

Introduction: Decitabine has shown clinical benefits in patients with intermediate (INT)-2 or high-risk myelodysplastic syndrome (MDS), determined according to the International Prognostic Scoring System (IPSS), but the benefits have not been well demonstrated in patients with lower-risk (IPSS low or INT-1) disease. Recently, it was proposed that the prognosis for patients with IPSS lower-risk disease is heterogeneous, with a substantial proportion of these patients having poor survival. Patients and Methods: This study included patients with IPSS lower-risk MDS from the DRAMA (An Observational Study for Dacogen Long-Term Treatment in Patients With Myelodysplastic Syndrome; NCT01400633) and DIVA (A Study for Dacogen Treatment in Patients With Myelodysplastic Syndrome; NCT01041846) studies, which were prospective observational studies on the efficacy and safety of decitabine treatment in patients with MDS. Using the Lower-Risk Prognostic Scoring System [LR-PSS], we classified IPSS lower-risk MDS. Patients in each LR-PSS category were divided according to overall response (OR) to decitabine treatment, and survival outcomes were compared. Results: One hundred sixteen patients were enrolled: LR-PSS category 1 (n = 12; 10.3%), category 2 (n = 56; 48.3%), and category 3 (n = 48; 41.4%). Survival outcomes differed among the 3 categories (P =.046). The overall survival according to OR showed a significant difference in total patients (P =.008) and category 3 patients (P =.003). We analyzed predictive factors for OR, but no variable was found to significantly affect OR. Conclusion: Decitabine treatment showed a survival benefit in the higher-risk group of IPSS lower-risk MDS patients who responded to treatment, and classification using the LR-PSS category was helpful for this subgroup, indicating that decitabine treatment might alter the natural course of disease in these patients.

Original languageEnglish
JournalClinical Lymphoma, Myeloma and Leukemia
DOIs
Publication statusPublished - 2019 Jan 1

Keywords

  • Decitabine
  • IPSS
  • Lower-Risk Prognostic Scoring System
  • LR-PSS
  • Myelodysplastic syndrome

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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    Jung, K. S., Kim, Y. J., Kim, Y. K., Park, S. K., Kim, H. G., Kim, S. J., Park, J., Choi, C. W., Do, Y. R., Kim, I., Park, S., Mun, Y. C., Jeong, S. H., Kim, M. K., Yi, H. G., Chang, M. H., Kim, S. Y., Lee, J. H., & Jang, J. H. (2019). Clinical Outcomes of Decitabine Treatment for Patients With Lower-Risk Myelodysplastic Syndrome on the Basis of the International Prognostic Scoring System. Clinical Lymphoma, Myeloma and Leukemia. https://doi.org/10.1016/j.clml.2019.06.003