Meet The Professors: Myelodysplastic Syndromes Edition, 2016Prognostic scoring systems in MDS
3:19 minutes.
TRANSCRIPTION:
DR RUPARD: There are 4 scoring systems. There’s the MD Anderson one. There’s the IPSS, revised IPSS and the WHO has a scoring system. Which one do you gentlemen use, and which one do you prefer? DR ERBA: I use the Erba scoring system. That’s how quickly they can go from the chair to the table. I mean, no, actually performance status is really important and it’s included in some but not all. I still use the old International Prognostic Scoring System for all-comers, mostly because much of the correlations we’ve made in terms of prognosis and treatment algorithms are still based on that. I use the nuances that are incorporated into the other scoring systems, as added information, plus other things that aren’t in the scoring systems, like marrow fibrosis. Not included anywhere in any of those scoring systems. But I’ve never seen a good outcome unless it’s this rare autoimmune myelofibrosis. So I still use International Prognostic Scoring System, but then borrow things I like, like blasts between 4% and 5%, which is in your scoring system and also the revised and the karyotypic changes. Things kind of make it up. DR GARCIA-MANERO: Of course my practice is only MDS/AML. But I use all. Actually, the one that I use the least, the IPSS-R. But I think in an academic practice, you need to come view this by IPSS-R. So you cannot get out of the way of it. I totally agree with Harry, because all the drugs that we have are approved under some type of FAB/IPSS type of approach, you have to use IPSS. But I’ll make a point here. That is this, actually: If you’re going to do something for your patient, this is critical. This actually is not academic. For most patients, really understanding what is going to happen to them is key. And they may say, “I don’t want therapy” or “I want therapy,” but that’s key. I cannot tell you how many times these kind of patients, okay, they have in their heads some very specific things. And they want to go to the wedding of their granddaughter 6 months from now. I mean, you think this guy’s — what I’m saying is silly. Listen, this type of geriatric practice, they are interested in this type of things. Okay? And they really need to understand their survival. So IPSS-R is powerful, so you use it. For therapy indication, IPSS is very simple. The problem with IPSS-R, you need to use the phone, or whatever. I’m part of that paper. I cannot recall it. There’s so many cytogenetics you cannot do this. And then, when it comes to the lower risk, the lower-risk model from MD Anderson is not mandatory, but it will allow you — and actually you have to think this model comes in every single analysis — it will allow with precision to tell your patient “your survival is this” or “your survival is that” and therefore I’m going to start some type of therapy. So this, actually, together with the morphology that you were discussing at the beginning, are probably the 2 most important things you want to do with your patient. One hundred percent sure that you have a morphologic diagnosis with the cytogenetics molecular. And when you have that, at night you don’t need to do that in front of the patient. You can do that the next day, your administrative day. Calculate their survival on a couple of these scores so you have a good picture. |