Prognostic impact of severe thrombocytopenia in low-risk myelodysplastic syndrome

BACKGROUND:

Thrombocytopenia is very common in myelodysplastic syndrome (MDS); however, its clinical impact in low‐risk patients remains controversial.

METHODS:

The authors analyzed the incidence and prognostic significance of thrombocytopenia at diagnosis in 2565 de novo MDS patients included in the Spanish MDS Registry.

RESULTS:

Thrombocytopenia (platelet count <100 × 10⁹/L) was identified in 842 patients (32.8%). Severe thrombocytopenia (platelet count <30 × 10⁹/L) was observed in 7.1% of patients and was significantly associated with a higher‐risk World Health Organization subtype (P = .026) and intermediate‐2/high‐risk International Prognostic Scoring System (IPSS) score (P = .046). Severe thrombocytopenia was the most important prognostic factor and had negative effects on the low/intermediate‐1 risk group. Median overall survival of patients with a platelet count <30 and ≥30 × 10⁹/L was 16 months and 71 months, respectively (hazard ratio, 4.66; 95% confidence interval, 2.74‐7.90; P < .0001). The negative effect of severe thrombocytopenia in low/intermediate‐1 risk patients was caused by increased risk of bleeding.

CONCLUSIONS:

MDS patients with low/intermediate‐1 IPSS risk score and severe thrombocytopenia should no longer be regarded as low risk, and must be considered for disease‐altering approaches at diagnosis. Cancer 2011;. © 2011 American Cancer Society.