Diagnostic Scoring and Assessing MDS Severity

Diagnostic Scoring

Diagnosing myelodysplastic syndromes (MDS) is a complex and lengthy process that involves first ruling out other causes for reported symptoms. Myelodysplasia may result from vitamin deficiencies and viral infections, as well as from antibiotic use, chemotherapy, or exposure to ethanol or benzene. Consequently, diagnosis requires detailed patient histories, physical examinations, laboratory testing, and extensive blood counts and analyses.¹³

The only diagnostic tool for MDS is a bone marrow biopsy. These examine the morphologies of marrow and blood cells, which provide definitive diagnostic information. Dysplastic cells often are misshapen and have visibly abnormal chromosomes, and a finding of abnormal chromosomes in the marrow indicates neoplasia. The most common cytogenetic abnormalities are a loss or gain of part or all of chromosomes 5, 7, 8 and 20.¹³

Assessing Disease Severity and Determining Treatment

Once a diagnosis of MDS is made, the International Prognostic Scoring System (IPSS) may be applied to assess disease severity and determine treatment for MDS.¹⁵ Disease variables such as ≥ 10% bone marrow blasts, poor cytogenetics,* multiple cytopenias and transfusion burden can be indicative of a poor prognosis.^4-7

Table 1. International Prognostic Scoring Classification for MDS⁷

Karyotype: the chromosomal characteristics of a cell¹⁹

* Complex karyotype (i.e., ≥ 3 abnormalities) or chromosome 7 abnormality.

In addition to IPSS, physicians may consider other factors, such as performance status, patient age and treatment history, when selecting an appropriate treatment plan for aggressive MDS.⁶

Table 2. IPSS Classification for MDS^7†

An Intermediate-1 score can be seen as aggressive disease when accompanied by poor cytogenetics or multiple cytopenias.⁶

† DACOGEN is indicated for treatment of patients with myelodysplastic syndromes (MDS) including previously treated and untreated, de novo and secondary MDS of all French-American-British subtypes (refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, and chronic myelomonocytic leukemia) and Intermediate-1, Intermediate-2, and High-Risk International Prognostic Scoring System groups.

Read about Epigenetics and the Role of Methylation in MDS.

References

IMPORTANT SAFETY INFORMATION

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