Optimizing Prognostic Assessment in De Novo Myelodysplastic Syndromes: Using WHO Classification and IPSS-R Criteria in focus: A Single-Centre Study
Keywords:
Cytopenia, Epidemiology, Myelodysplastic Syndromes, Prognosis, Risk AssessmentAbstract
OBJECTIVE: To assess clinicopathological, morphological and molecular characterization in De Novo Myelodysplastic patients (MDS).
METHODOLOGY: This prospective observational study was conducted at NIBD between December 2022 and March 2025. The study included 100 adult patients diagnosed with de novo MDS according to the WHO 2017 criteria. Demographic and clinical variables, as well as laboratory indices, were collected, alongwith bone marrow evaluation and karyotyping. We classified patients according to the WHO 2017 subtypes and assigned them to IPSS-R risk groups. Survival was estimated using the Kaplan–Meier method, and differences in overall survival among MDS subtypes were compared using the log-rank test. Statistical significance was set at p < 0.05.
RESULTS: Median patient age was 54 years (IQR 40–65), with male predominance (64%). The most prevalent WHO subtype MDS unclassifiable(38%), followed MDS-EB1?EB1 (21%) and MDS-EB2?EB2 (20%). Regarding IPSS-R, 14% of patients were classified as low risk, 54% as intermediate risk, and the remainder as high/very high risk. The cohort’s median overall survival, calculated from the time of diagnosis to death or last follow-up, was approximately 24 months. Notably, severe cytopenias were linked with survival: patients with haemoglobin levels between 8–<10?g/dL exhibited a median survival of 8 months, while those with platelet counts <?50?×?10?/L or absolute neutrophil count (<?0.8?×?10?/L) survived approximately 16 months. IPSS?R risk categories demonstrated significant associations with hematologic parameters (all p???0.02).
CONCLUSION: In de novo MDS, WHO 2017 subtypes and IPSS-R jointly refine prognosis. Younger-onset cases and frequent unclassifiable cases highlight the value of integrated morphologic–cytogenetic assessment.
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