@article{3104904,
    title = "Serum ferritin and ECOG performance status predict the response and improve the prognostic value of IPSS or IPSS-R in patients with high-risk myelodysplastic syndromes and oligoblastic acute myeloid leukemia treated with 5-azacytidine: a retrospective analysis of the Hellenic national registry of myelodysplastic and hypoplastic syndromes",
    author = "Papageorgiou, S.G. and Kotsianidis, I. and Bouchla, A. and Symeonidis, A. and Galanopoulos, A. and Viniou, N.-A. and Hatzimichael, E. and Vassilakopoulos, T.P. and Gogos, D. and Megalakaki, A. and Zikos, P. and Diamantopoulos, P. and Kourakli, A. and Giannoulia, P. and Papoutselis, M. and Poulakidas, E. and Arapaki, M. and Vardi, A. and Anagnostopoulos, A. and Mparmparousi, D. and Papaioannou, M. and Bouronikou, E. and Dimou, M. and Papadaki, H. and Panayiotidis, P. and Pappa, V.",
    journal = "Therapeutic Advances in Hematology",
    year = "2020",
    volume = "11",
    publisher = "SAGE Publications Ltd",
    issn = "2040-6207, 2040-6215",
    doi = "10.1177/2040620720966121",
    keywords = "alpha 2 globulin;  azacitidine;  C reactive protein;  granulocyte colony stimulating factor, acute myeloid leukemia;  adult;  aged;  Article;  biochemical analysis;  blood transfusion;  bone marrow biopsy;  bone marrow suppression;  bone marrow toxicity;  cytogenetics;  disease free survival;  dysplasia;  erythrocyte;  erythropoiesis;  female;  ferritin blood level;  human;  human tissue;  International Prognostic Scoring System;  International Prostate Symptom Score;  major clinical study;  male;  myelodysplastic syndrome;  overall survival;  prognosis;  progression free survival;  retrospective study;  risk assessment;  survival analysis;  thrombocyte transfusion;  treatment failure",
    abstract = "Background: 5-azacytidine (5-AZA) improves survival of patients with higher-risk myelodysplastic syndromes (MDSs) and oligoblastic acute myeloid leukemia (AML); however, predictive factors for response and outcome have not been consistently studied. Methods: This study of the Hellenic MDS Study Group included 687 consecutive patients with higher-risk MDS and oligoblastic AML treated with 5-AZA. Results: The International Prognostic Scoring System (IPSS) revised version (IPSS-R), Eastern Cooperative Oncology Group Performance Status (ECOG PS) (0 or 1 versus ⩾2) and baseline serum ferritin (SF) levels > 520 ng/ml were shown to independently predict response to 5-AZA. In the survival analysis, the IPSS and IPSS-R risk classification systems along with the ECOG PS and SF levels > 520 ng/ml proved to be independent prognosticators for overall survival (OS), as well as for leukemia-free survival (LFS). Next, we built new multivariate models for OS and LFS, incorporating only ECOG PS and SF levels besides IPSS or IPSS-R risk classification systems. Thereby, the new modified IPSS and IPSS-R risk classification systems (H-PSS, H-PSS-R) could each discriminate a low, an intermediate and a high-risk patient group regarding OS and LFS. The H-PSS and H-PSS-R proved to be better predictors of OS than their previous counterparts as well as the French prognostic score, while the most powerful OS predictor was the new, H-PSS-R system. Conclusions: ECOG PS and SF levels > 520 ng/ml independently predict response to 5-AZA, OS and LFS. Their incorporation in the IPSS and IPSS-R scores enhances these scores’ predictive power in 5-AZA-treated higher-risk MDS and oligoblastic AML patients. © The Author(s), 2020."
}